Provider Demographics
NPI:1306816749
Name:BULATAO, PETER T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:BULATAO
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 1:542 BRAVES FIELD DR
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-4596
Mailing Address - Country:US
Mailing Address - Phone:210-563-8003
Mailing Address - Fax:
Practice Address - Street 1:230 DUNCAN DR BLDG #1440
Practice Address - Street 2:TUTTLE HEALTH CLINIC
Practice Address - City:HUNTER ARMY AIRFIELD
Practice Address - State:GA
Practice Address - Zip Code:31409-0000
Practice Address - Country:US
Practice Address - Phone:210-563-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034620L183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist