Provider Demographics
NPI:1053720474
Name:PETITT, MARK L (PHARMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:PETITT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HIGHLANDS SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-5732
Mailing Address - Country:US
Mailing Address - Phone:828-698-6282
Mailing Address - Fax:828-698-6282
Practice Address - Street 1:300 HIGHLANDS SQUARE DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5732
Practice Address - Country:US
Practice Address - Phone:828-698-6282
Practice Address - Fax:828-698-6282
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist