Provider Demographics
NPI:1912358748
Name:PETTY, DEMPSEY L (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEMPSEY
Middle Name:L
Last Name:PETTY
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 1:4701 HWY 101
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439
Mailing Address - Country:US
Mailing Address - Phone:541-902-7333
Mailing Address - Fax:541-902-7327
Practice Address - Street 1:4701 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-8807
Practice Address - Country:US
Practice Address - Phone:541-902-7333
Practice Address - Fax:541-902-7327
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0015161183500000X, 1835P0018X
CTPCT.0013365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist