Provider Demographics
NPI:1346420486
Name:SOMERVILLE, PETER W JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:W
Last Name:SOMERVILLE
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 WALTER AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-4035
Mailing Address - Country:US
Mailing Address - Phone:716-694-8868
Mailing Address - Fax:
Practice Address - Street 1:343 MEADOW DR
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2815
Practice Address - Country:US
Practice Address - Phone:716-694-8868
Practice Address - Fax:716-694-6771
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist