Provider Demographics
NPI:1922608454
Name:PITTS, VANESSA ANN MARIE RITA (RPH)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANN MARIE RITA
Last Name:PITTS
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:PO BOX 2424
Mailing Address - Street 2:
Mailing Address - City:HELENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:92342-2424
Mailing Address - Country:US
Mailing Address - Phone:760-987-0936
Mailing Address - Fax:
Practice Address - Street 1:26365 BUCCANEER LN
Practice Address - Street 2:
Practice Address - City:HELENDALE
Practice Address - State:CA
Practice Address - Zip Code:92342-7739
Practice Address - Country:US
Practice Address - Phone:760-987-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA830883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY5174255OtherDRIVER LICENSE