Healthcare Provider Details

I. General information

NPI: 1922608454
Provider Name (Legal Business Name): VANESSA ANN MARIE RITA PITTS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26365 BUCCANEER LN
HELENDALE CA
92342-7739
US

IV. Provider business mailing address

PO BOX 2424
HELENDALE CA
92342-2424
US

V. Phone/Fax

Practice location:
  • Phone: 760-987-0936
  • Fax:
Mailing address:
  • Phone: 760-987-0936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number83088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: