Provider Demographics
NPI:1962032896
Name:TOLENTINO, VICTORIA LAUREN (PHARMD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LAUREN
Last Name:TOLENTINO
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 1:1775 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5732
Mailing Address - Country:US
Mailing Address - Phone:928-763-8777
Mailing Address - Fax:
Practice Address - Street 1:1775 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5732
Practice Address - Country:US
Practice Address - Phone:928-763-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8759128-17011835P0018X
NV197151835P0018X
AZS0244351835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist