Provider Demographics
NPI:1104411818
Name:PETERS, RAEYANNA JAZLYHN
Entity type:Individual
Prefix:
First Name:RAEYANNA
Middle Name:JAZLYHN
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 S ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:MI
Mailing Address - Zip Code:48851-8626
Mailing Address - Country:US
Mailing Address - Phone:616-902-3770
Mailing Address - Fax:
Practice Address - Street 1:3062 S STATE RD
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-8777
Practice Address - Country:US
Practice Address - Phone:616-527-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician