MICHAEL T PETERS
1919 Vista Del Lago Dr Ste 6
Valley Springs, CA 95252
209-772-1633
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 3336C0004X | Suppliers - Pharmacy - Compounding Pharmacy | ||
N | 3336M0002X | Suppliers - Pharmacy | ||
Y | 3336C0003X | Suppliers - Pharmacy | CA | PHY49019 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
NCPDP PROVIDER IDENTIFICATION NUMBER | 5631191 | OTHER |