Provider Demographics
NPI:1679885313
Name:KLITOFSKY, PETA A (RPH)
Entity Type:Individual
Prefix:
First Name:PETA
Middle Name:A
Last Name:KLITOFSKY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8512 CLIFFRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2110
Mailing Address - Country:US
Mailing Address - Phone:858-455-5482
Mailing Address - Fax:
Practice Address - Street 1:4840 NIAGARA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3115
Practice Address - Country:US
Practice Address - Phone:619-222-7503
Practice Address - Fax:619-222-4926
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist