Provider Demographics
NPI:1760704449
Name:BARTOLUCCI, ALAN SCOT
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:SCOT
Last Name:BARTOLUCCI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:SCOT
Other - Last Name:BARTOLUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3501 XENIUM LN N APT 315
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2224
Mailing Address - Country:US
Mailing Address - Phone:970-403-5399
Mailing Address - Fax:
Practice Address - Street 1:250 W 65TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4668
Practice Address - Country:US
Practice Address - Phone:970-461-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2003395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist