Basic Information
| Provider Information | |||||||||
| NPI: | 1124257704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | CHERIE | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GOTO | ||||||||
| OtherFirstName: | CHERIE | ||||||||
| OtherMiddleName: | K. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PHARM.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | US ARMY HEALTH CLINIC SCHOFIELD BARRACKS | ||||||||
| Address2: | PHARMACY SERVICE BLDG 676, ROOM 104 | ||||||||
| City: | SCHOFIELD BARRACKS | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968575460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084338423 | ||||||||
| FaxNumber: | 8084338417 | ||||||||
| Practice Location | |||||||||
| Address1: | SCHOFIELD BARRACKS | ||||||||
| Address2: | BLDG 683, ROOM 104 | ||||||||
| City: | SCHOFIELD BARRACKS | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968575460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084338291 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2009 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | PH 3125 | HI | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 183500000X | PH60072007 | WA | N | Pharmacy Service Providers | Pharmacist |
No ID Information.