Provider Demographics
NPI:1801065784
Name:PETER, AJI SHIBU (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:AJI
Middle Name:SHIBU
Last Name:PETER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HAMBLETONIAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1021
Mailing Address - Country:US
Mailing Address - Phone:845-469-3184
Mailing Address - Fax:
Practice Address - Street 1:154 HAMBLETONIAN AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-1021
Practice Address - Country:US
Practice Address - Phone:845-469-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist