DR. GARY PHILLIP PETERSON (NPI# 1619258639) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619258639 |
| Entity Type | Individual |
| Full Name | DR. GARY PHILLIP PETERSON |
| Credential | PHARMD |
| Practice Address |
2404 S Perryville Rd Rockford IL 61108-8231 |
| Practice Telephone | 8153323256 |
| Practice Fax Number | 8153324180 |
| Mailing Telephone | 8153323256 |
| Mailing Fax Number | 8153324180 |
| Enumeration Date | 2011-09-03 |
| Last Update Date | 2011-09-03 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 051.290809 | IL | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417299074 | Gary L Peterson | Veterinarian | 1220 S State St, Salt Lake City, UT 84111-4535 | 2013-03-21 |
| 1447557616 | Gary G Peterson | Physical Therapist | 4461 Woodbridge Rd, Niceville, FL 32578-2387 | 2011-02-23 |
| 1114130465 | Gary Glen Peterson | Psychologist | 675 Sun Valley Road, C, Ketchum, ID 83340 | 2007-05-07 |
| 1518006147 | Gary S Peterson | Dentist | 123 S Stone Ave, Tucson, AZ 85701-1914 | 2007-02-06 |
| 1164589610 | Gary Robert Peterson | Counselor | 1538 The Greens Way Ste 101, Jacksonville Beach, FL 32250-1400 | 2007-01-03 |
| 1285799304 | Gary Ray Peterson | Dentist | 3815 Stephens Ave, Missoula, MT 59801-8505 | 2006-12-27 |
| 1629163514 | Gary Lee Peterson | Chiropractor | 7100 Menaul Blvd Ne, Albuquerque, NM 87110-3688 | 2006-10-04 |
| 1417065566 | Gary Peterson | Psychiatry & Neurology | 103 Edwards Ridge Rd, Chapel Hill, NC 27517-9201 | 2006-08-28 |
| 1699724955 | Gary M Peterson | Family Medicine | 4702 Grand Ave, Duluth, MN 55807-2742 | 2006-05-06 |
| 1831541812 | Gary Daniel Peterson | Anesthesiology | 6000 Hospital Dr, Hannibal, MO 63401-6887 | 2016-07-01 |
| Street Address |
2404 S PERRYVILLE RD |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61108-8231 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376785667 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 2404 S Perryville Rd, Rockford, IL 61108-8231 | 2009-04-01 |
| 1598230765 | Maura Sullivan | Pharmacist | 2404 S Perryville Rd, Rockford, IL 61108-8231 | 2018-10-03 |
| 1144503442 | Rebecca Diane Bogacki | Pharmacist | 2404 S Perryville Rd, Rockford, IL 61108-8231 | 2011-09-22 |
| 1386926590 | Sharon Mcauliffe | Pharmacist | 2404 S Perryville Rd, Rockford, IL 61108-8231 | 2011-09-13 |
| 1952681694 | Andrew Joseph Davis | Pharmacist | 2404 S Perryville Rd, Rockford, IL 61108-8231 | 2011-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952862617 | Isr Enterprises, Inc. | Homemaker | 129 Phelps Ave, Bldg 10, Ste 1008, Rockford, IL 61108 | 2019-03-26 |
| 1003306465 | Adrienne Nicole Black | Behavior Technician | 519 Woodland Dr, Woodland Dr, Rockford, IL 61108 | 2018-05-11 |
| 1184085201 | Integrative Healing Center, LLC | Clinic/Center | 6019 Fincham Drive, Rockford, IL 61108 | 2016-03-17 |
| 1730547936 | Perryville Dentist PC | Dentist | 845 S Perryville Rd, Unit 119, Rockford, IL 61108 | 2016-02-02 |
| 1023489853 | Nicole Ping Ticknor | Counselor | 433 S. Phelps Ave., Suite 2, Rockford, IL 61108 | 2015-10-20 |
| 1275940348 | Northwest Home Care, Inc. | Home Health | 1437 S. Bell School Road, Suite 7, Rockford, IL 61108 | 2014-07-21 |
| 1487072922 | Alecia Greenlee | Psychiatry & Neurology | Rosecrance Community Mental Health, 3815 Harrison Avenue, Rockford, IL 61108 | 2014-04-02 |
| 1871925446 | Maria Laura Gustafson | Interpreter | 3208 Wesleyan Ave., Rockford, IL 61108 | 2013-08-06 |
| 1346582822 | Joseph Peevey | Pathology | 5666 E State Street, Department of Pathology, Rockford, IL 61108 | 2013-03-21 |
| 1134466923 | James Henry Peck | Hearing Instrument Specialist | 2424 Charles St, Rockford, IL 61108 | 2013-01-14 |
| Find all providers in zip 61108 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356952139 | Jessica Marie Tamayo Fernandez | Pharmacist | 1145 Alpine Rd, Rockford, IL 61107 | 2020-08-13 |
| 1447875604 | Paulushi Patel | Pharmacist | 2013 Mcfarland Rd, Rockford, IL 61107-6835 | 2020-06-13 |
| 1174009765 | Lynn Carlson | Pharmacist | 1672 Peconic Pl, Rockford, IL 61108-7033 | 2018-07-17 |
| 1700374568 | Zarin F Haider | Pharmacist | 2662 Elmwood Rd Ste 101, Rockford, IL 61103-1573 | 2018-04-27 |
| 1932624400 | Desmond Anthony Harold | Pharmacist | 250 Marcell Dr Ne Apt 9, Rockford, MI 49341-1380 | 2017-08-07 |
| 1528503216 | Miles Skalnek | Pharmacist | 511 10 Mile Road, Rockford, MI 49341 | 2017-01-04 |
| 1629526421 | Chi Zhang | Pharmacist | 8628 Blue River Rd, Rockford, IL 61107-5304 | 2016-09-21 |
| 1255701595 | Patrick Donohoo | Pharmacist | 291 Bienterra Trl Apt 5, Rockford, IL 61107-5890 | 2015-09-29 |
| 1346676582 | Christopher Anthony Ziganto | Pharmacist | 494 Bienterra Trail #2, Rockford, IL 61107 | 2013-09-19 |
| 1801234224 | David Thomas Storm | Pharmacist | 4404 E State St, Suite 402, Rockford, IL 61108-2115 | 2013-06-07 |
| Find all providers in ROCKFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.