Provider Demographics
NPI:1710437447
Name:NUTI, JILL (RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:NUTI
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 1:805 EASTBROOK CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-1206
Mailing Address - Country:US
Mailing Address - Phone:925-830-0555
Mailing Address - Fax:925-830-0450
Practice Address - Street 1:124 MARKET PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4740
Practice Address - Country:US
Practice Address - Phone:925-830-0555
Practice Address - Fax:925-830-0450
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist