Provider Demographics
NPI:1558641209
Name:ROTUNNO, PAUL JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:ROTUNNO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2732
Mailing Address - Country:US
Mailing Address - Phone:970-356-4093
Mailing Address - Fax:
Practice Address - Street 1:2600 11TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-8441
Practice Address - Country:US
Practice Address - Phone:970-475-0554
Practice Address - Fax:970-475-0644
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist