Provider Demographics
NPI:1548263221
Name:PETERS, AUGUST RICHARD IV (RPH)
Entity type:Individual
Prefix:MR
First Name:AUGUST
Middle Name:RICHARD
Last Name:PETERS
Suffix:IV
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 1:1902 W WEBB AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-1062
Mailing Address - Country:US
Mailing Address - Phone:336-584-3736
Mailing Address - Fax:336-584-3735
Practice Address - Street 1:1902 W WEBB AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-1062
Practice Address - Country:US
Practice Address - Phone:336-584-3736
Practice Address - Fax:336-584-3735
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703170Medicaid
NC7703170Medicaid