Provider Demographics
NPI:1790242808
Name:PETERSEN, BRITTANI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRITTANI
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BRITTANI
Other - Middle Name:
Other - Last Name:COBBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1852
Mailing Address - Country:US
Mailing Address - Phone:385-440-1222
Mailing Address - Fax:385-489-8813
Practice Address - Street 1:265 N STATE ST
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1852
Practice Address - Country:US
Practice Address - Phone:385-440-1222
Practice Address - Fax:385-489-8813
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6123340-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty