Healthcare Provider Details

I. General information

NPI: 1063724102
Provider Name (Legal Business Name): DANA NOEL PETRI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 ENVIRON WAY
CHAPEL HILL NC
27517-4418
US

IV. Provider business mailing address

1106 ENVIRON WAY
CHAPEL HILL NC
27517-4418
US

V. Phone/Fax

Practice location:
  • Phone: 919-918-7595
  • Fax: 919-933-3954
Mailing address:
  • Phone: 919-918-7595
  • Fax: 919-933-3954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21155
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: