Provider Demographics
NPI:1730269929
Name:PETERS, KATHRYN EILENE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:EILENE
Last Name:PETERS
Suffix:
Gender:F
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 1:100 PRISON RD
Mailing Address - Street 2:
Mailing Address - City:REPRESA
Mailing Address - State:CA
Mailing Address - Zip Code:95671-3000
Mailing Address - Country:US
Mailing Address - Phone:916-985-8610
Mailing Address - Fax:916-294-3114
Practice Address - Street 1:100 PRISON RD
Practice Address - Street 2:
Practice Address - City:REPRESA
Practice Address - State:CA
Practice Address - Zip Code:95671-3000
Practice Address - Country:US
Practice Address - Phone:916-985-8610
Practice Address - Fax:916-294-3114
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 38246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist