Provider Demographics
NPI:1922375393
Name:PEDALINO, ANTHONY EDWARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:EDWARD
Last Name:PEDALINO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 WEST LN
Mailing Address - Street 2:RM 2L03 - CLINICAL OPERATIONS PHARMACY
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3377
Mailing Address - Country:US
Mailing Address - Phone:760-702-1775
Mailing Address - Fax:209-455-3062
Practice Address - Street 1:7373 WEST LN
Practice Address - Street 2:RM 2L03 - CLINICAL OPERATIONS PHARMACY
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3377
Practice Address - Country:US
Practice Address - Phone:760-702-1775
Practice Address - Fax:209-455-3062
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA66342OtherCALIFORNIA BOARD OF PHARMACY -- REGISTERED PHARMACIST