Provider Demographics
NPI:1235620436
Name:PETTITT, BROOKE FREEMAN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:FREEMAN
Last Name:PETTITT
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 1:400 S JENNINGS AVE APT 144
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2334
Mailing Address - Country:US
Mailing Address - Phone:803-899-9543
Mailing Address - Fax:
Practice Address - Street 1:7828 PINEVILLE MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3910
Practice Address - Country:US
Practice Address - Phone:704-341-2019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist