Provider Demographics
NPI:1467896266
Name:TALLUTO, CARRIE LYNN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LYNN
Last Name:TALLUTO
Suffix:
Gender:F
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 1:8607 SE MERRITT WAY
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-1007
Mailing Address - Country:US
Mailing Address - Phone:561-743-5585
Mailing Address - Fax:
Practice Address - Street 1:2901 SW PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3222
Practice Address - Country:US
Practice Address - Phone:772-336-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist