Provider Demographics
NPI:1316252299
Name:PETTIT, ROBIN P (PHARMD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:P
Last Name:PETTIT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N HIGHWAY 171
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-5343
Mailing Address - Country:US
Mailing Address - Phone:337-855-4848
Mailing Address - Fax:
Practice Address - Street 1:120 N HIGHWAY 171
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-5343
Practice Address - Country:US
Practice Address - Phone:337-855-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist