Active NPI
Noland Peterdy, PHARMD, JD, MBA
- Pharmacist
- Liberty Lake, WA
National Provider Identifier
1841627601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 39210
- Practice address
- 1423 N Molter 727
Liberty Lake, WA 99019 - Phone
- (509) 220-7512
- NPI assigned
- Oct 10, 2013
- Sex
- Male
- 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 | 39210 | WA | Primary |
Addresses
Primary practice location
1423 N Molter 727
Liberty Lake, WA 99019
Mailing address
Box 727
Liberty Lake, WA 99019
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
- Juris Doctor, Master of Business Administration, Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39210 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1381363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381363200000",
"number": "1841627601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "BOX 727",
"city": "LIBERTY LAKE",
"state": "WA",
"postal_code": "99019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1423 N MOLTER 727",
"city": "LIBERTY LAKE",
"state": "WA",
"postal_code": "99019",
"telephone_number": "509-220-7512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERDY",
"first_name": "NOLAND",
"credential": "PHARMD, JD, MBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-10-10",
"last_updated": "2013-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "39210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Liberty Lake, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.