Provider Demographics
NPI:1578834636
Name:PITTMAN, CAROLYN D (RPH)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:D
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BIRCH ACRES
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:ME
Mailing Address - Zip Code:04002-6080
Mailing Address - Country:US
Mailing Address - Phone:207-499-2969
Mailing Address - Fax:
Practice Address - Street 1:14 BIRCH ACRES
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:ME
Practice Address - Zip Code:04002-6080
Practice Address - Country:US
Practice Address - Phone:207-499-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist