Provider Demographics
NPI:1275117251
Name:PETIT, SHARON L
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:PETIT
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 1:697 TAMARAC TRL
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-2367
Mailing Address - Country:US
Mailing Address - Phone:330-714-8826
Mailing Address - Fax:330-706-0270
Practice Address - Street 1:3200 GREENWICH RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-5764
Practice Address - Country:US
Practice Address - Phone:330-825-2573
Practice Address - Fax:330-706-0270
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03315812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist