Provider Demographics
NPI:1457684508
Name:TILTON, PAULINE MINH (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:MINH
Last Name:TILTON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MRS
Other - First Name:PAULINE
Other - Middle Name:MINH
Other - Last Name:TILTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:15020 JOSHUA ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3811
Mailing Address - Country:US
Mailing Address - Phone:760-524-9911
Mailing Address - Fax:760-524-9908
Practice Address - Street 1:14555 VALLEY CENTER DR
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4216
Practice Address - Country:US
Practice Address - Phone:760-524-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist