Provider Demographics
NPI:1093997538
Name:PETTIT, STEVEN M (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:PETTIT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 LILLIAN MILLER PKWY
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-2902
Mailing Address - Country:US
Mailing Address - Phone:940-577-2912
Mailing Address - Fax:940-898-1986
Practice Address - Street 1:2500 LILLIAN MILLER PKWY
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-2902
Practice Address - Country:US
Practice Address - Phone:940-382-1618
Practice Address - Fax:940-898-1986
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist