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General NPI Number Information
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NPI Number | 1760777411
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Entity Type | Individual
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Provider Name | CHRISTINA BRUECKNER PETTIT PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 06/10/2011
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Provider Practice Location Address
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Address Line | 1300 LONG GROVE DR TARGET PHARMACY T-1529
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-9462
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Country | US
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Telephone | 843-388-8769
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 LONG GROVE DR TARGET PHARMACY T-1529
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-9462
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Country | US
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Telephone | 843-388-8769
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Fax |
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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 | 11042
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2004009928
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License Number State | MO
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