Eric D Peterson, R.PH.

Key facts

NPI

1962169474

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist 183500000X

License

1-11372 (KS)

Practice address

716 N 4TH St
Burlington, KS 66839-1286

Phone

(620) 364-3388

Fax

(620) 364-3381

NPI assigned

Nov 18, 2021

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Registered Pharmacist

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 18, 2021.

{
    "created_epoch": "1637193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1962169474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 N 4TH ST",
            "city": "BURLINGTON",
            "state": "KS",
            "postal_code": "668391286",
            "telephone_number": "620-364-3388",
            "fax_number": "620-364-3381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 N 4TH ST",
            "city": "BURLINGTON",
            "state": "KS",
            "postal_code": "668391286",
            "telephone_number": "620-364-3388",
            "fax_number": "620-364-3381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ERIC",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "R.PH.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-18",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "KS",
            "license": "1-11372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Burlington, KS · Pharmacist in Kansas