Provider Demographics
NPI:1639117096
Name:TULLIO, CARL JOSEPH (BS, MS, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOSEPH
Last Name:TULLIO
Suffix:
Gender:M
Credentials:BS, MS, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PASTURE LN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-2594
Mailing Address - Country:US
Mailing Address - Phone:757-868-5814
Mailing Address - Fax:
Practice Address - Street 1:205 PASTURE LN
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-2594
Practice Address - Country:US
Practice Address - Phone:757-868-5814
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011942183500000X
PARP026713L183500000X
FLPS24193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP026713LOtherPHARMACIST LICENSE
VA0202011942OtherPHARMACIST LICENSE
FLPS24193OtherPHARMACIST LICENSE