Provider Demographics
NPI:1851924559
Name:PETERS, EMMA (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:PETERS
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 1:4518 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-1206
Mailing Address - Country:US
Mailing Address - Phone:608-222-3648
Mailing Address - Fax:608-222-4971
Practice Address - Street 1:4518 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-1206
Practice Address - Country:US
Practice Address - Phone:608-222-3648
Practice Address - Fax:608-222-4971
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist