NPIMap

Individual provider Active NPI

Bradley Tyler Peterson, PHARMD

  • Pharmacist
  • Cornelius, NC
National Provider Identifier
1558181784
Registry record updated Jul 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
34821 Issued in NC
Practice address
8315 Magnolia Estates Dr
Cornelius, NC 28031-7837
Phone
(704) 895-7062
NPI assigned
Oct 14, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X I-49482 SC
Pharmacist 183500000X 34821 NC Primary
Student in an Organized Health Care Education/Training Program 390200000X 02537 NC

Addresses

Primary practice location

8315 Magnolia Estates Dr
Cornelius, NC 28031-7837

Mailing address

13334 Old Store Rd
Huntersville, NC 28078-7435

Other practice location 1

620 Long Point Rd
Mount Pleasant, SC 29464-8363
Phone (843) 856-4902

Other practice location 2

9925 Rose Commons Dr
Huntersville, NC 28078-3335
Phone (704) 875-2375

Other names 1

  • Dr. Brad Peterson Other name

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

LicenseStateTypeSpecialty
I-49482SCMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Harris Teeter LLC PastSince Oct 20, 2024 Accepting new patients
Publix North Carolina LP Past Accepting new patients
Publix North Carolina, LP Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1728864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785024000000",
    "number": "1558181784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13334 OLD STORE RD",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8315 MAGNOLIA ESTATES DR",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280317837",
            "telephone_number": "704-895-7062"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "620 Long Point Rd",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "SC",
            "postal_code": "294648363",
            "country_code": "US",
            "telephone_number": "843-856-4902",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9925 Rose Commons Dr",
            "address_purpose": "LOCATION",
            "city": "Huntersville",
            "state": "NC",
            "postal_code": "280783335",
            "country_code": "US",
            "telephone_number": "704-875-2375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BRADLEY",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-14",
        "last_updated": "2026-07-26",
        "certification_date": "2026-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "SC",
            "license": "I-49482",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NC",
            "license": "34821",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": "02537",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRAD",
            "last_name": "PETERSON",
            "prefix": "DR.",
            "credential": "PHARMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cornelius, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.