Provider Demographics
NPI:1407123706
Name:SCOTTO DI PALUMBO, MICHAEL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SCOTTO DI PALUMBO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 W SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745
Mailing Address - Country:US
Mailing Address - Phone:310-507-0021
Mailing Address - Fax:
Practice Address - Street 1:651 W SEPULVEDA BLVD
Practice Address - Street 2:T-2328
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-6314
Practice Address - Country:US
Practice Address - Phone:310-507-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist