| Organization Name: | VERNON E PETERSON |
| NPI Number: | 1689655243 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VERNON PETERSON (OWNER PHARMACIST) |
| Mailing Address: | 1007 3rd Ave Mountain Lake |
| State: | MN US |
| Postal Code: | 561591587 |
| Phone Number: | 5074272707 |
| Fax Number: | 5074272328 |
| NPI Enumeration Date: | 11/10/2005 |
| NPI Last Update Date: | 01/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 333600000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |