Provider Demographics
NPI:1518214006
Name:ASSA-KRUTILIN, URI S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:URI
Middle Name:S
Last Name:ASSA-KRUTILIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4788 LAKERUN CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-5131
Mailing Address - Country:US
Mailing Address - Phone:714-264-2761
Mailing Address - Fax:
Practice Address - Street 1:4788 LAKERUN CT
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-5131
Practice Address - Country:US
Practice Address - Phone:714-264-2761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60254646183500000X
NV18266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist