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NPI Code Detail

MEDICARE: MR. JAMES A. PETTUS R.PH.

MEDICARE:  MR. JAMES A. PETTUS  R.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist007298KY

General Provider Information

NPI Number : 1003804220
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES A. PETTUS R.PH.
Provider Business Mailing Address
First Line : 12383 ANGLERS CV
Second Line :
City : FORT MYERS
State : FL
Zip : 33908-1891
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3033 WINKLER AVENUE EXT
Second Line :
City : FORT MYERS
State : FL
Zip : 33916-9413
Country : US
Telephone Number : 239-939-3939
Fax Number : 239-931-6109
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 07/16/2007

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Directions to “ MR. JAMES A. PETTUS R.PH.” Practice Location

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