Active NPI
Mark Eugene Petersen, PHARMD
- Pharmacist
- Othello, WA
National Provider Identifier
1548608649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH60341057
- Practice address
- 140 E Main St
Othello, WA 99344-1040 - Phone
- (509) 488-5256
- Fax
- (509) 331-1612
- NPI assigned
- Jun 11, 2013
- 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 | PH60341057 | WA | Primary |
Addresses
Primary practice location
140 E Main St
Othello, WA 99344-1040
Mailing address
140 E Main St
Othello, WA 99344-1040
Phone (509) 488-5256
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH60341057 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370908800000",
"number": "1548608649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 E MAIN ST",
"city": "OTHELLO",
"state": "WA",
"postal_code": "993441040",
"telephone_number": "509-488-5256",
"fax_number": "509-331-1612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 E MAIN ST",
"city": "OTHELLO",
"state": "WA",
"postal_code": "993441040",
"telephone_number": "509-488-5256",
"fax_number": "509-331-1612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "MARK",
"middle_name": "EUGENE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-11",
"last_updated": "2013-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH60341057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Othello, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.