Provider Demographics
NPI:1669708814
Name:PETERSON, DAVID GERARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GERARD
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 1:3441 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-1545
Mailing Address - Country:US
Mailing Address - Phone:919-387-4124
Mailing Address - Fax:919-387-0841
Practice Address - Street 1:3441 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-1545
Practice Address - Country:US
Practice Address - Phone:919-387-4124
Practice Address - Fax:919-387-0841
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist