Provider Demographics
NPI:1770637365
Name:TENETTE, PAUL ANTHONY (RPN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ANTHONY
Last Name:TENETTE
Suffix:
Gender:M
Credentials:RPN
Other - Prefix:
Other - First Name:DELTA
Other - Middle Name:
Other - Last Name:DRUGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:DELTA DRUGS
Mailing Address - Street 2:1666 N MEDICAL CENTER DRIVE
Mailing Address - City:SAN BERNADINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411
Mailing Address - Country:US
Mailing Address - Phone:909-887-2596
Mailing Address - Fax:909-887-8496
Practice Address - Street 1:DELTA DRUGS
Practice Address - Street 2:1666 N MEDICAL CENTER DRIVE
Practice Address - City:SAN BERNADINO
Practice Address - State:CA
Practice Address - Zip Code:92411
Practice Address - Country:US
Practice Address - Phone:909-887-2596
Practice Address - Fax:909-887-8496
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA 374500Medicaid