Provider Demographics
NPI:1831470780
Name:BARTOLUCCI, TATIANA ELISA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:ELISA
Last Name:BARTOLUCCI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2879
Mailing Address - Country:US
Mailing Address - Phone:502-526-2957
Mailing Address - Fax:
Practice Address - Street 1:3421 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-2872
Practice Address - Country:US
Practice Address - Phone:502-776-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist