Provider Demographics
NPI:1235882242
Name:PETITTE, MORGAN KATE
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:KATE
Last Name:PETITTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 SOUTHVIEW ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2409
Mailing Address - Country:US
Mailing Address - Phone:304-685-1254
Mailing Address - Fax:
Practice Address - Street 1:3040 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-0577
Practice Address - Country:US
Practice Address - Phone:304-285-7216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0010542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist