Provider Demographics
NPI:1295315406
Name:PETERS, DEMONTRION CORDERO (PHARM D)
Entity type:Individual
Prefix:
First Name:DEMONTRION
Middle Name:CORDERO
Last Name:PETERS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 HILLCROFT ST STE 602
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5847
Mailing Address - Country:US
Mailing Address - Phone:713-289-4825
Mailing Address - Fax:281-720-5131
Practice Address - Street 1:2909 HILLCROFT ST STE 602
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5847
Practice Address - Country:US
Practice Address - Phone:713-289-4825
Practice Address - Fax:281-720-5131
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy