Active NPI
Frederick N Peterson
- Pharmacist
- Stanford, IN
National Provider Identifier
1356911937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26018068A
- Practice address
- 9048 W State Road 45 # 221
Stanford, IN 47463-9000 - Phone
- (765) 729-5479
- NPI assigned
- Jun 28, 2021
- Last updated
- Jun 28, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26018068A | IN | Primary |
Addresses
Primary practice location
9048 W State Road 45 # 221
Stanford, IN 47463-9000
Mailing address
PO Box 221
Stanford, IN 47463-0221
Phone (765) 729-5479
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26018068A | IN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624838400000",
"number": "1356911937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 221",
"city": "STANFORD",
"state": "IN",
"postal_code": "474630221",
"telephone_number": "765-729-5479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9048 W STATE ROAD 45 # 221",
"city": "STANFORD",
"state": "IN",
"postal_code": "474639000",
"telephone_number": "765-729-5479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "FREDERICK",
"middle_name": "N",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-28",
"last_updated": "2021-06-28",
"certification_date": "2021-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26018068A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.