Provider Demographics
NPI:1649560954
Name:PETERS, BRYAN PETER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:PETER
Last Name:PETERS
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 1:21754 EASTMERE LN
Mailing Address - Street 2:
Mailing Address - City:FRIANT
Mailing Address - State:CA
Mailing Address - Zip Code:93626-9753
Mailing Address - Country:US
Mailing Address - Phone:559-325-2537
Mailing Address - Fax:559-354-5213
Practice Address - Street 1:21754 EASTMERE LN
Practice Address - Street 2:
Practice Address - City:FRIANT
Practice Address - State:CA
Practice Address - Zip Code:93626-9753
Practice Address - Country:US
Practice Address - Phone:559-325-2537
Practice Address - Fax:559-354-5213
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 51322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist