Provider Demographics
NPI:1699835538
Name:PETERS, COLIN ANTHONY SR (RPH)
Entity type:Individual
Prefix:MR
First Name:COLIN
Middle Name:ANTHONY
Last Name:PETERS
Suffix:SR
Gender:M
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:PO BOX 167
Mailing Address - Street 2:
Mailing Address - City:NARROWSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12764-0167
Mailing Address - Country:US
Mailing Address - Phone:845-252-3003
Mailing Address - Fax:845-252-3616
Practice Address - Street 1:141 KIRKS RD
Practice Address - Street 2:
Practice Address - City:NARROWSBURG
Practice Address - State:NY
Practice Address - Zip Code:12764-6431
Practice Address - Country:US
Practice Address - Phone:845-252-3003
Practice Address - Fax:845-252-3616
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01344590Medicaid
PA0015104750001Medicaid