Provider Demographics
NPI:1811351976
Name:PRETORIUS, PIETER
Entity type:Individual
Prefix:
First Name:PIETER
Middle Name:
Last Name:PRETORIUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 NUGENT LOOP
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-2214
Mailing Address - Country:US
Mailing Address - Phone:302-743-5360
Mailing Address - Fax:
Practice Address - Street 1:1001 N DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-2006
Practice Address - Country:US
Practice Address - Phone:302-674-8392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist