Active NPI
Gordon E Peterson, PHARM.D
- Pharmacist
- Villa Park, CA
National Provider Identifier
1841510708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 22984
- Practice address
- 18561 Rosenau Cir
Villa Park, CA 92861-2847 - Phone
- (714) 390-5075
- NPI assigned
- Jun 2, 2010
- 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 | 22984 | CA | Primary |
Addresses
Primary practice location
18561 Rosenau Cir
Villa Park, CA 92861-2847
Mailing address
18561 Rosenau Cir
Villa Park, CA 92861-2847
Phone (714) 390-5075
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 |
|---|---|---|---|
| 22984 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278288000000",
"number": "1841510708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18561 ROSENAU CIR",
"city": "VILLA PARK",
"state": "CA",
"postal_code": "928612847",
"telephone_number": "714-390-5075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18561 ROSENAU CIR",
"city": "VILLA PARK",
"state": "CA",
"postal_code": "928612847",
"telephone_number": "714-390-5075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "GORDON",
"middle_name": "E",
"credential": "PHARM.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-02",
"last_updated": "2010-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "22984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Villa Park, CA
- Aniko F Lengyel, PHARM D, CNS
- Samantha Markovitz, NBC-HWC
- Armine Martirosian, DDS
- Mei C Chou Acupuncture and Herbs, Inc.
- Frank Edward Obuljen, MD
- Sam Joseph Poidmore, D,D,S,
- Ramirez Anesthesia and Nursing Inc.
- Recovery Bay Rehabilitation Center (Path to Serenity)
- Recovery Bay Rehabilitation Center, LLC (Addiction Recovery Rehab)
- Remedx, Inc. (RemedX)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.