Healthcare Provider Details

I. General information

NPI: 1740843192
Provider Name (Legal Business Name): CAROL LISA PETRIN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 04/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 CALLE REAL
GOLETA CA
93117-2313
US

IV. Provider business mailing address

347 POR LA MAR CIR
SANTA BARBARA CA
93103-3790
US

V. Phone/Fax

Practice location:
  • Phone: 805-967-5677
  • Fax:
Mailing address:
  • Phone: 805-455-5288
  • Fax: 805-967-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: