Provider Demographics
NPI:1962013946
Name:PITRE, MARIUS JOSEPH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIUS
Middle Name:JOSEPH
Last Name:PITRE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 BARNA AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-5452
Mailing Address - Country:US
Mailing Address - Phone:321-269-7392
Mailing Address - Fax:
Practice Address - Street 1:2605 BARNA AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5452
Practice Address - Country:US
Practice Address - Phone:321-269-7392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist