Provider Demographics
NPI:1245562313
Name:PETERSONCOMPOUNDING PLLC
Entity Type:Organization
Organization Name:PETERSONCOMPOUNDING PLLC
Other - Org Name:COMPOUNDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:870-562-2901
Mailing Address - Street 1:608 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3121
Mailing Address - Country:US
Mailing Address - Phone:870-562-2901
Mailing Address - Fax:870-562-2903
Practice Address - Street 1:608 E NORTH ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3121
Practice Address - Country:US
Practice Address - Phone:870-562-2901
Practice Address - Fax:870-562-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR PD 08327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty