Provider Demographics
NPI:1740406370
Name:PETERS, SARA B (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:B
Last Name:PETERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 S LOOMIS RD
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9753
Mailing Address - Country:US
Mailing Address - Phone:989-227-0017
Mailing Address - Fax:989-227-0016
Practice Address - Street 1:6750 S LOOMIS RD
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9753
Practice Address - Country:US
Practice Address - Phone:989-227-0017
Practice Address - Fax:989-227-0016
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
MI5302025937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist