Provider Demographics
NPI:1215296538
Name:PETITTO, FRANK JOSEPH JR (RPH)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:JOSEPH
Last Name:PETITTO
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 BARKSDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4555
Mailing Address - Country:US
Mailing Address - Phone:318-549-2107
Mailing Address - Fax:318-549-2110
Practice Address - Street 1:4918 BARKSDALE BLVD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4555
Practice Address - Country:US
Practice Address - Phone:318-549-2107
Practice Address - Fax:318-549-2110
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist