Provider Demographics
NPI:1679695035
Name:PETERSON, JAMES ANDERS (PHARMD BCPS BCPP)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANDERS
Last Name:PETERSON
Suffix:
Gender:M
Credentials:PHARMD BCPS BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 E CORONADO CIR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-2336
Mailing Address - Country:US
Mailing Address - Phone:480-893-6908
Mailing Address - Fax:
Practice Address - Street 1:5203 E CORONADO CIRCLE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-2336
Practice Address - Country:US
Practice Address - Phone:480-893-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ91551835P1200X, 1835P1300X
IL0051-0362241835P1200X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric