James Robert Petersen, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

14811 Issued in IA

Practice address

4000 University Ave
Waterloo, IA 50701-5640

Phone

(319) 236-1786

Fax

(319) 236-0074

NPI assigned

May 24, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922219641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 BOBBI LN",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507013230",
            "telephone_number": "319-236-1786",
            "fax_number": "319-236-0074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 UNIVERSITY AVE",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507015640",
            "telephone_number": "319-236-1786",
            "fax_number": "319-236-0074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JAMES",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IA",
            "license": "14811",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IA",
            "license": "IA14811",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peoples Community Health Clinic, Inc
• Peoples Community Health Clinic, Inc
• Peoples Community Health Clinic, Inc.
• Peoples Community Health Clinic, Inc.
• Michael F. Peters, M.D.
• Neal Petersen, TLMHC
• Adaline Lee Peterson, A.R.N.P.
• Benjamin Robert Peterson, DDS
• Jacob John Peterson, PHARMD
• Jaden Peterson

• Pharmacist in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Pharmacist in Iowa

• 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.

Verify at the official NPI Registry.