Provider Demographics
NPI:1831465673
Name:TARANTINO, SALVATORE PHILLIP (RPH)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:PHILLIP
Last Name:TARANTINO
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 1:2010 SHADOW CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510
Mailing Address - Country:US
Mailing Address - Phone:661-400-7034
Mailing Address - Fax:
Practice Address - Street 1:3720 WEST SIERRA HIGHWAY UNIT G
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:CA
Practice Address - Zip Code:93510
Practice Address - Country:US
Practice Address - Phone:661-269-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist