Provider Demographics
NPI:1689827677
Name:ANDERSON, PETER DAVID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DAVID
Last Name:ANDERSON
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 1:816 WILLARD ST
Mailing Address - Street 2:APT. 207
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7496
Mailing Address - Country:US
Mailing Address - Phone:617-769-9955
Mailing Address - Fax:
Practice Address - Street 1:816 WILLARD ST
Practice Address - Street 2:APT. 207
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7496
Practice Address - Country:US
Practice Address - Phone:617-769-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210401835P0018X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist