Provider Demographics
NPI:1447676259
Name:PETERS, STEPHEN G (RPH)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:G
Last Name:PETERS
Suffix:
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 1:2306 PEACOCK LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-1712
Mailing Address - Country:US
Mailing Address - Phone:205-616-7784
Mailing Address - Fax:205-820-9153
Practice Address - Street 1:2306 PEACOCK LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-1712
Practice Address - Country:US
Practice Address - Phone:205-616-7784
Practice Address - Fax:205-820-9153
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9408183500000X
FL18498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18498OtherPHARMACIST
AL9408OtherPHARMACIST