Active NPI
Stephanie Marie Petersen, PHARMD
- Pharmacist
- Council Bluffs, IA
National Provider Identifier
1982192720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19167
- Practice address
- 3201 Manawa Centre Dr
Council Bluffs, IA 51501-7674 - Phone
- (712) 366-1315
- Fax
- (712) 366-0708
- NPI assigned
- Apr 26, 2018
- Sex
- Female
- 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 | 19167 | IA | Primary |
Addresses
Primary practice location
3201 Manawa Centre Dr
Council Bluffs, IA 51501-7674
Mailing address
3201 Manawa Centre Dr
Council Bluffs, IA 51501-7674
Phone (712) 366-1315
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 |
|---|---|---|---|
| 19167 | IA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524700800000",
"number": "1982192720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3201 MANAWA CENTRE DR",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515017674",
"telephone_number": "712-366-1315",
"fax_number": "712-366-0708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3201 MANAWA CENTRE DR",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515017674",
"telephone_number": "712-366-1315",
"fax_number": "712-366-0708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "STEPHANIE",
"middle_name": "MARIE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-26",
"last_updated": "2018-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "19167",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Council Bluffs, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.