MICHAEL TODD PETTIT (NPI# 1518234590) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518234590 |
| Entity Type | Individual |
| Full Name | MICHAEL TODD PETTIT |
| Credential | RPH |
| Practice Address |
2508 W Broadway Council Bluffs IA 51501-3509 |
| Practice Telephone | 7123282266 |
| Practice Fax Number | 7123289063 |
| Mailing Telephone | 7123282266 |
| Mailing Fax Number | 7123289063 |
| Enumeration Date | 2011-11-19 |
| Last Update Date | 2011-11-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | 10065 | NE | Pharmacy Service Providers |
| Y | 183500000X | Pharmacist | 15543 | IA | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629383559 | Michael Rand Pettit | Pharmacist | 114 Gloria Dr, Lake Charles, LA 70611 | 2010-08-16 |
| 1215013891 | Michael James Pettit | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2006-10-27 |
| Street Address |
2508 W BROADWAY |
| City | COUNCIL BLUFFS |
| State | IA |
| Zip Code | 51501-3509 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689287302 | Lynn Tang | Pharmacist | 2508 W Broadway, Council Bluffs, IA 51501-3509 | 2020-08-24 |
| 1699305748 | Ahmed Morsy | Pharmacist | 2508 W Broadway, Council Bluffs, IA 51501-3509 | 2020-01-16 |
| 1518520055 | Katherine Schoeneck | Pharmacist | 2508 W Broadway, Council Bluffs, IA 51501-3509 | 2019-04-19 |
| 1750780417 | Edward Aaron Rastovski | Pharmacist | 2508 W Broadway, Council Bluffs, IA 51501-3509 | 2014-08-19 |
| 1740557057 | April Davidson | Pharmacist | 2508 W Broadway, Council Bluffs, IA 51501-3509 | 2011-11-30 |
| 1982971099 | Nancy Ilene Gau | Pharmacist | 2508 W Broadway, Council Bluffs, IA 51501-3509 | 2011-11-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881204691 | Melissa Sue Sperry | Counselor | Melissa Sperry, 4036 Ramelle Dr, Council Bluffs, IA 51501 | 2020-08-06 |
| 1326689076 | Crc Recovery, Inc. | Clinic/Center | 1750 W Broadway, Council Bluffs, IA 51501 | 2019-10-03 |
| 1518451152 | Naomi Kigondu | Registered Nurse | 2323 W Broadway Ste 100, Council Bluffs, IA 51501 | 2018-06-18 |
| 1710400361 | Travis John Alger | Chiropractor | 3424 W Broadway, Council Bluffs, IA 51501 | 2017-07-25 |
| 1124495692 | Jillian Kahl | Speech-Language Pathologist | 1500 N 16th St, Council Bluffs, IA 51501 | 2015-08-31 |
| 1932584323 | Leigh Healey | Dietitian, Registered | 2323 West Broadway, Council Bluffs, IA 51501 | 2015-07-27 |
| 1942558523 | Karen Irene Godin | Registered Nurse | 1702 N 16th Street, Council Bluffs, IA 51501 | 2012-08-29 |
| 1063787505 | Rebecca F Aboe | Dietitian, Registered | 1702 North 16th St., Council Bluffs, IA 51501 | 2012-03-16 |
| 1972883122 | Sara Ann Lott | Occupational Therapist | 1310 N. 17th St., Council Bluffs, IA 51501 | 2011-08-19 |
| 1700042884 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 3271 Marketplace Dr, Council Bluffs, IA 51501 | 2008-07-29 |
| Find all providers in zip 51501 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952920092 | Leigh Taylor Jorgenson | Pharmacist | 1745 Madison Ave Ste 1, Council Bluffs, IA 51503-5274 | 2020-04-09 |
| 1689028219 | Carl Dean Smith | Pharmacist | 310 Fleming Ave, Council Bluffs, IA 51503-1406 | 2016-04-20 |
| 1063780179 | Mike Snook | Pharmacist | 12250 Woodland Trl, Council Bluffs, IA 51503-6402 | 2011-12-02 |
| 1376865105 | Lyndsey Oltmans | Pharmacist | 2803 E Kanesville Blvd, Council Bluffs, IA 51503-1004 | 2010-02-21 |
| 1902031446 | Peggy C. Hausmann | Pharmacist | 2528 Thallas St, Council Bluffs, IA 51503-8600 | 2009-05-28 |
| 1427176973 | Amanda Autumn Duysen | Pharmacist | 1706 North 16th Street, Council Bluffs, IA 51501 | 2007-03-26 |
| 1417074220 | Madonna M Weidman | Pharmacist | 1706 N 16th St, Council Bluffs, IA 51501-0121 | 2007-03-25 |
| 1821128257 | Anne Louise Starr | Pharmacist | 1801 Valley View Drive, Council Bluffs, IA 51503 | 2007-03-06 |
| 1992830517 | Roger W Snook | Pharmacist | 133 Zenith Dr, Council Bluffs, IA 51503-0282 | 2007-02-22 |
| 1639215825 | Sheila Mary Wettengel | Pharmacist | 101 Woodcliff Cir, Council Bluffs, IA 51503-4288 | 2007-01-29 |
| Find all providers in COUNCIL BLUFFS | ||||
| City | COUNCIL BLUFFS |
| Zip Code | 51501 |
Please comment or provide details below to improve the information on MICHAEL TODD PETTIT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.