Provider Demographics
NPI:1568688182
Name:PETERSEN, PAUL E (PHARMD,BCPS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:PHARMD,BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5702
Mailing Address - Country:US
Mailing Address - Phone:615-612-2729
Mailing Address - Fax:
Practice Address - Street 1:425 5TH AVE N
Practice Address - Street 2:1ST FLOOR CHB
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37243-0001
Practice Address - Country:US
Practice Address - Phone:615-741-8529
Practice Address - Fax:615-741-3857
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN117661835P1200X
CA531911835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy