Provider Demographics
NPI:1649971516
Name:PETERSON, ALEXANDER TUCKER (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:TUCKER
Last Name:PETERSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 W 1280 N
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9093
Mailing Address - Country:US
Mailing Address - Phone:435-882-0150
Mailing Address - Fax:435-882-1023
Practice Address - Street 1:99 W 1280 N
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-9093
Practice Address - Country:US
Practice Address - Phone:435-882-0150
Practice Address - Fax:435-882-1023
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10898394-17013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy