Provider Demographics
NPI:1457636938
Name:DITTMAR, PAULA (RPH)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:DITTMAR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 MORENA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3650
Mailing Address - Country:US
Mailing Address - Phone:858-581-4550
Mailing Address - Fax:858-581-4424
Practice Address - Street 1:4605 MORENA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3650
Practice Address - Country:US
Practice Address - Phone:858-581-4550
Practice Address - Fax:858-581-4424
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
CA421251835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist