Provider Demographics
NPI:1225470545
Name:PETERS, DAMIAN EDWARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:EDWARD
Last Name:PETERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-3908
Mailing Address - Country:US
Mailing Address - Phone:732-266-2090
Mailing Address - Fax:888-495-9659
Practice Address - Street 1:604 PARK AVE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3908
Practice Address - Country:US
Practice Address - Phone:732-266-2090
Practice Address - Fax:888-495-9659
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-28
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02761000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist