Provider Demographics
NPI:1740843192
Name:PETRIN, CAROL LISA (RPH)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LISA
Last Name:PETRIN
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 1:347 POR LA MAR CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-3790
Mailing Address - Country:US
Mailing Address - Phone:805-455-5288
Mailing Address - Fax:805-967-2200
Practice Address - Street 1:5875 CALLE REAL
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-2313
Practice Address - Country:US
Practice Address - Phone:805-967-5677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist