Provider Demographics
NPI:1811591035
Name:PITTS, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:PITTS
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 1:6162 N COUNTY ROAD 800 E
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IN
Mailing Address - Zip Code:47031-9230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 S HIGH ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:IN
Practice Address - Zip Code:47042-9523
Practice Address - Country:US
Practice Address - Phone:812-689-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016581A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist