Provider Demographics
NPI:1225154644
Name:PETERSEN, ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:PETERSEN
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 1:2917 THISTLEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-5251
Mailing Address - Country:US
Mailing Address - Phone:804-864-0488
Mailing Address - Fax:
Practice Address - Street 1:9645 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4116
Practice Address - Country:US
Practice Address - Phone:804-965-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist