Provider Demographics
NPI:1932534179
Name:PITTS, ELWOOD JR (CPHT)
Entity Type:Individual
Prefix:MR
First Name:ELWOOD
Middle Name:
Last Name:PITTS
Suffix:JR
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:STE 100
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-822-4588
Mailing Address - Fax:804-965-0987
Practice Address - Street 1:5000 COX RD
Practice Address - Street 2:STE 100
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-9263
Practice Address - Country:US
Practice Address - Phone:804-822-4588
Practice Address - Fax:804-965-0987
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230008417183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician