Provider Demographics
NPI:1073910527
Name:PETERSON SANDERS, ANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PETERSON SANDERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 N SAMPSON ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5345
Mailing Address - Country:US
Mailing Address - Phone:920-257-3037
Mailing Address - Fax:
Practice Address - Street 1:513 N SAMPSON ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5345
Practice Address - Country:US
Practice Address - Phone:920-257-3037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist