Provider Demographics
NPI:1265854343
Name:PETERSONRX, LLC
Entity Type:Organization
Organization Name:PETERSONRX, LLC
Other - Org Name:PETERSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOW
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-721-0137
Mailing Address - Street 1:125 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1639
Mailing Address - Country:US
Mailing Address - Phone:732-721-0137
Mailing Address - Fax:732-721-0134
Practice Address - Street 1:125 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1639
Practice Address - Country:US
Practice Address - Phone:732-721-0137
Practice Address - Fax:732-721-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS005598003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy