Most Relevant Information
Provider Data
| NPI Number: | 1003403775 |
| Provider Name: | NICHOLAS PETTY PHARMD |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | PS58943 |
Most Important Dates
| Enumeration Date: | 12/28/2020 |
| Last Updated: | 12/28/2020 |
Provider Practice Location
15180 TAMIAMI TRL
NORTH PORT
FL
342872742
Practice Location Phone/Fax
| Phone: | 9414236700 |
| Fax: |
Provider Mailing Location
5081 WINTER ROSE WAY
VENICE
FL
342938213
Provider Mailing Phone/Fax
| Phone: | 9706850407 |
| Fax: |