Michael Carroll Petitt, RPH, PHARM.D.

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

043550 Issued in TN

Practice address

650 Joel Dr
Fort Campbell, KY 42223-5318

Phone

(270) 412-9109

Fax

(270) 412-4601

NPI assigned

Sep 13, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy, Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1902575947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235318",
            "telephone_number": "270-412-9109",
            "fax_number": "270-412-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235318",
            "telephone_number": "270-412-9109",
            "fax_number": "270-412-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETITT",
        "first_name": "MICHAEL",
        "middle_name": "CARROLL",
        "credential": "RPH, PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-13",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "TN",
            "license": "043550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Peters, ATC, AT, M.ED
• Amanda Mae Peterson, CNM, WHNP-BC
• Christopher Alyn Peterson, PA-C
• Kimberley Ann Peterson, MSW, LICSW
• Rachel Elaine Peterson, LCSW
• Shell Marie Pfeiffer, LCSW
• Anh Ngoc Pham, PA
• Naomi Phayne, DPM
• Kasey Marie Phillips
• Kimberley Jo Phillips, MD, MPH

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.