Provider Demographics
NPI:1659590081
Name:PETERS, GERARD PHILIP (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:PHILIP
Last Name:PETERS
Suffix:
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 1:18112 ROYAL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3189
Mailing Address - Country:US
Mailing Address - Phone:813-994-8422
Mailing Address - Fax:
Practice Address - Street 1:2540 E BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-5069
Practice Address - Country:US
Practice Address - Phone:813-972-2446
Practice Address - Fax:813-972-2096
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist