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NPI Code Detail

MEDICARE: NICHOLAS PETTY PHARMD

MEDICARE: NICHOLAS PETTY PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS58943FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PS58943OTHERFLPHARMACIST LICENSE

General Provider Information

NPI Number : 1003403775
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS PETTY PHARMD
Provider Business Mailing Address
First Line : 5081 WINTER ROSE WAY
Second Line :
City : VENICE
State : FL
Zip : 34293-8213
Country : US
Telephone Number : 970-685-0407
Fax Number :
Provider Business Practice Location Address
First Line : 15180 TAMIAMI TRL
Second Line :
City : NORTH PORT
State : FL
Zip : 34287-2742
Country : US
Telephone Number : 941-423-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2020
Last Update Date : 12/28/2020

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Directions to “ NICHOLAS PETTY PHARMD” Practice Location

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