Provider Demographics
NPI:1962922302
Name:PETERSON, BARBARA JO (RPH)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JO
Last Name:PETERSON
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 1:246 ELM ST W
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55302-1123
Mailing Address - Country:US
Mailing Address - Phone:320-274-3062
Mailing Address - Fax:320-274-6546
Practice Address - Street 1:246 ELM ST W
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:MN
Practice Address - Zip Code:55302-1123
Practice Address - Country:US
Practice Address - Phone:320-274-3062
Practice Address - Fax:320-274-6546
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist