Provider Demographics
NPI:1760009039
Name:PETERSON, LAUREN L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:L
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-1581
Mailing Address - Country:US
Mailing Address - Phone:856-300-2455
Mailing Address - Fax:
Practice Address - Street 1:1111 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-1581
Practice Address - Country:US
Practice Address - Phone:856-300-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451681183500000X
NJ28RI03872400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist