Provider Demographics
NPI:1023399474
Name:PETERSEN, KATHERINE RENEE (RPH)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:RENEE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:EPPING
Mailing Address - State:NH
Mailing Address - Zip Code:03042-2542
Mailing Address - Country:US
Mailing Address - Phone:603-734-4290
Mailing Address - Fax:
Practice Address - Street 1:12 MAIN ST
Practice Address - Street 2:
Practice Address - City:EPPING
Practice Address - State:NH
Practice Address - Zip Code:03042-2425
Practice Address - Country:US
Practice Address - Phone:603-679-5839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19652183500000X
NHR2191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist