Active NPI
Lena Pettus, PHARMD
- Pharmacist
- Salem, MO
National Provider Identifier
1801523667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2017011706
- Practice address
- 1204 E Scenic Rivers Blvd
Salem, MO 65560-2843 - Phone
- (573) 729-4091
- Fax
- (573) 729-2394
- NPI assigned
- Aug 2, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2017011706 | MO | Primary |
Addresses
Primary practice location
1204 E Scenic Rivers Blvd
Salem, MO 65560-2843
Mailing address
465 County Road 5120
Salem, MO 65560-8124
Phone (573) 247-4698
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017011706 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659398400000",
"number": "1801523667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "465 COUNTY ROAD 5120",
"city": "SALEM",
"state": "MO",
"postal_code": "655608124",
"telephone_number": "573-247-4698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1204 E SCENIC RIVERS BLVD",
"city": "SALEM",
"state": "MO",
"postal_code": "655602843",
"telephone_number": "573-729-4091",
"fax_number": "573-729-2394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTUS",
"first_name": "LENA",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-02",
"last_updated": "2022-08-02",
"certification_date": "2022-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2017011706",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.