Provider Demographics
NPI:1639405491
Name:DITULLIO, PATRICK (RPH)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:DITULLIO
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 1:1814 SHEFFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5721
Mailing Address - Country:US
Mailing Address - Phone:916-783-4830
Mailing Address - Fax:
Practice Address - Street 1:1814 SHEFFIELD WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5721
Practice Address - Country:US
Practice Address - Phone:916-783-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 63067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist