Provider Demographics
NPI:1427323146
Name:PETERSON, ALEX MICHAEL (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:MICHAEL
Last Name:PETERSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13717 NW 2ND AVE APT 64
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-1901
Mailing Address - Country:US
Mailing Address - Phone:702-217-2135
Mailing Address - Fax:
Practice Address - Street 1:6720 NE 84TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-2016
Practice Address - Country:US
Practice Address - Phone:360-828-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17637183500000X
CO18355183500000X
WAPH 60196181183500000X
OR12862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist