Provider Demographics
NPI:1215234075
Name:FITTE ENTERPRISES, INC.
Entity type:Organization
Organization Name:FITTE ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FITTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-343-9649
Mailing Address - Street 1:29291 TRIBUNE BLVD
Mailing Address - Street 2:UNIT 2-3
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33955-2216
Mailing Address - Country:US
Mailing Address - Phone:941-575-2407
Mailing Address - Fax:941-575-4820
Practice Address - Street 1:29291 TRIBUNE BLVD
Practice Address - Street 2:UNIT 2-3
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33955-2216
Practice Address - Country:US
Practice Address - Phone:941-575-2407
Practice Address - Fax:941-575-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH250933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5704071OtherNCPDP PROVIDER IDENTIFICATION NUMBER