Active NPI
Mary Janeen Petersen, PHARM D
- Pharmacist
- Livermore, CA
National Provider Identifier
1609176163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 52613
- Practice address
- 4495 First St
Livermore, CA 94551-4915 - Phone
- (925) 455-2522
- Fax
- (925) 455-2525
- NPI assigned
- Oct 29, 2010
- Sex
- Female
- 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 | 52613 | CA | Primary |
Addresses
Primary practice location
4495 First St
Livermore, CA 94551-4915
Mailing address
4495 First St
Livermore, CA 94551-4915
Phone (925) 455-2522
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 |
|---|---|---|---|
| 52613 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safeway Inc | Past | Accepting new patients | |
| Safeway Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Retail Pharmacy
- Livermore, CA
- NPI 1598701104
-
- Community/Retail Pharmacy
- Queen Creek, AZ
- NPI 1730040973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553126400000",
"number": "1609176163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4495 FIRST ST",
"city": "LIVERMORE",
"state": "CA",
"postal_code": "945514915",
"telephone_number": "925-455-2522",
"fax_number": "925-455-2525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4495 FIRST ST",
"city": "LIVERMORE",
"state": "CA",
"postal_code": "945514915",
"telephone_number": "925-455-2522",
"fax_number": "925-455-2525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "MARY",
"middle_name": "JANEEN",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-29",
"last_updated": "2019-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "52613",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livermore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.