Provider Demographics
NPI:1477875813
Name:PETERSON, SETH (PHARN D)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:PHARN D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TECHNOLOGY PL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9713
Mailing Address - Country:US
Mailing Address - Phone:518-434-1980
Mailing Address - Fax:518-434-1985
Practice Address - Street 1:15 TECHNOLOGY PL
Practice Address - Street 2:SUITE 2
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9713
Practice Address - Country:US
Practice Address - Phone:518-434-1980
Practice Address - Fax:518-434-1985
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist