Provider Demographics
NPI:1316222854
Name:DITULLIO, ALEXANDER MARK
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:MARK
Last Name:DITULLIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 PARKHILL DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-2840
Mailing Address - Country:US
Mailing Address - Phone:513-598-5476
Mailing Address - Fax:
Practice Address - Street 1:9775 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1442
Practice Address - Country:US
Practice Address - Phone:513-385-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist