Provider Demographics
NPI:1215535448
Name:PETERS, KIKELOMO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIKELOMO
Middle Name:
Last Name:PETERS
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 1:4107 CROSSPOINT BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-1805
Mailing Address - Country:US
Mailing Address - Phone:832-419-3267
Mailing Address - Fax:956-292-0416
Practice Address - Street 1:4107 CROSSPOINT BLVD STE B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1805
Practice Address - Country:US
Practice Address - Phone:832-277-0370
Practice Address - Fax:956-292-0416
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist