Provider Demographics
NPI:1023101615
Name:PETERS, ALFREDA LLOYD (RPH)
Entity type:Individual
Prefix:
First Name:ALFREDA
Middle Name:LLOYD
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 1:625 GIANT OAK ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810
Mailing Address - Country:US
Mailing Address - Phone:863-687-8993
Mailing Address - Fax:863-647-2458
Practice Address - Street 1:6902 S. FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33617
Practice Address - Country:US
Practice Address - Phone:863-646-3617
Practice Address - Fax:863-647-2458
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0025892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist