Peterson Pharmacy Incorporated

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

260192 Issued in MN

Legal business name

PETERSON PHARMACY INCORPORATED

Doing business as

Peterson Pharmacy Inc.

Practice address

440 4TH St
Dassel, MN 55325-4543

Phone

(320) 275-3052

Fax

(320) 275-2591

NPI assigned

Feb 20, 2007

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Myron D Sylvester, RPH

Title

Pharmacist

Phone

(320) 275-3052

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Peterson Pharmacy Inc. Doing business as

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1780729848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 4TH ST",
            "address_2": "PO BOX 280",
            "city": "DASSEL",
            "state": "MN",
            "postal_code": "553254543",
            "telephone_number": "320-275-3052",
            "fax_number": "320-275-2591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 4TH ST",
            "city": "DASSEL",
            "state": "MN",
            "postal_code": "553254543",
            "telephone_number": "320-275-3052",
            "fax_number": "320-275-2591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON PHARMACY INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "SYLVESTER",
        "authorized_official_first_name": "MYRON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "320-275-3052",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "260192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "260192",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "840858100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2404399",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peterson Pharmacy Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Dassel, MN
• Providers in Dassel, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.