Provider Demographics
NPI:1568994424
Name:DYTIOCO, SOLITA
Entity Type:Individual
Prefix:MS
First Name:SOLITA
Middle Name:
Last Name:DYTIOCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PULLMAN, BLDG G
Mailing Address - Street 2:KAISER PERMANENTE
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-5060
Mailing Address - Country:US
Mailing Address - Phone:925-960-6996
Mailing Address - Fax:
Practice Address - Street 1:300 PULLMAN ST BLDG G
Practice Address - Street 2:KAISER PERMANENTE
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-9756
Practice Address - Country:US
Practice Address - Phone:925-960-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 46108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist