Provider Demographics
NPI:1124617527
Name:FLETCHER, PETRA ANNE
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:ANNE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E 232ND PL
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5311
Mailing Address - Country:US
Mailing Address - Phone:310-809-7387
Mailing Address - Fax:
Practice Address - Street 1:2001 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2604
Practice Address - Country:US
Practice Address - Phone:310-517-9535
Practice Address - Fax:310-517-9552
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH8046183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician