Provider Demographics
NPI:1730463514
Name:PETTIT, EMILY GRAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:GRAY
Last Name:PETTIT
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 1:1800 BAYTREE RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-3552
Mailing Address - Country:US
Mailing Address - Phone:229-242-4939
Mailing Address - Fax:229-242-7842
Practice Address - Street 1:1800 BAYTREE RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-3552
Practice Address - Country:US
Practice Address - Phone:229-242-4939
Practice Address - Fax:229-242-7842
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA24283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist