Provider Demographics
NPI:1952715492
Name:PETERITAS, CELESTE (RPH)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:PETERITAS
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 1:820 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-2405
Mailing Address - Country:US
Mailing Address - Phone:610-948-0838
Mailing Address - Fax:610-792-4014
Practice Address - Street 1:820 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-2405
Practice Address - Country:US
Practice Address - Phone:610-948-0838
Practice Address - Fax:610-792-4014
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist