Provider Demographics
NPI:1174852024
Name:PETERS, SYLVIA G
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:G
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MAXEY RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77013-5036
Mailing Address - Country:US
Mailing Address - Phone:713-330-4552
Mailing Address - Fax:713-330-4595
Practice Address - Street 1:500 MAXEY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77013-5036
Practice Address - Country:US
Practice Address - Phone:713-330-4552
Practice Address - Fax:713-330-4595
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4527694OtherNABP