Provider Demographics
NPI:1548605520
Name:PETERSON, GEOFFREY DAVID (PHARMD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:DAVID
Last Name:PETERSON
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 1:15 SMITHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5312
Mailing Address - Country:US
Mailing Address - Phone:401-353-4075
Mailing Address - Fax:
Practice Address - Street 1:15 SMITHFIELD RD
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5312
Practice Address - Country:US
Practice Address - Phone:401-353-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH06094183500000X
MAPH27443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist