Provider Demographics
NPI:1780284919
Name:PETTUS, CARRIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
Last Name:PETTUS
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 1:5225 ALEXANDER RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-3657
Mailing Address - Country:US
Mailing Address - Phone:540-674-5745
Mailing Address - Fax:540-674-5769
Practice Address - Street 1:5225 ALEXANDER RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3657
Practice Address - Country:US
Practice Address - Phone:540-674-5745
Practice Address - Fax:540-674-5769
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist