Provider Demographics
NPI:1033866611
Name:PELTS, SYDNEY LAUREN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:LAUREN
Last Name:PELTS
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 1:2 FAIRLANE DR
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-9633
Mailing Address - Country:US
Mailing Address - Phone:304-320-8383
Mailing Address - Fax:
Practice Address - Street 1:1322 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-5526
Practice Address - Country:US
Practice Address - Phone:540-953-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist