Active NPI
John G Petersen, RPH
- Pharmacist
- Pennsville, NJ
National Provider Identifier
1730294430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RI01431300
- Practice address
- 193 N Broadway
Pennsville, NJ 08070-1417 - Phone
- (856) 678-2122
- NPI assigned
- Aug 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 28RI01431300 | NJ | Primary |
Addresses
Primary practice location
193 N Broadway
Pennsville, NJ 08070-1417
Mailing address
4 Harvard Ave
Blackwood, NJ 08012-2510
Phone (856) 232-0230
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 28RI01431300 | Other | NJ | PHARMACIST LICENSE |
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI01431300 | NJ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730294430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 HARVARD AVE",
"city": "BLACKWOOD",
"state": "NJ",
"postal_code": "080122510",
"telephone_number": "856-232-0230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "193 N BROADWAY",
"city": "PENNSVILLE",
"state": "NJ",
"postal_code": "080701417",
"telephone_number": "856-678-2122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "JOHN",
"middle_name": "G",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI01431300",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "28RI01431300",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pennsville, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.