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General NPI Number Information
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NPI Number | 1740843192
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Entity Type | Individual
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Provider Name | CAROL LISA PETRIN RPH
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Gender | Female
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Dates
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Enumeration Date | 04/20/2019
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Last Update Date | 04/20/2019
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Provider Practice Location Address
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Address Line | 5875 CALLE REAL
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City | GOLETA
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State | CA
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Zip | 93117-2313
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Country | US
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Telephone | 805-967-5677
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Fax |
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Provider Business Mailing Address
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Address Line | 347 POR LA MAR CIR
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City | SANTA BARBARA
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State | CA
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Zip | 93103-3790
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Country | US
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Telephone | 805-455-5288
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Fax | 805-967-2200
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 29202
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License Number State | CA
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