Provider Demographics
NPI:1336418763
Name:DALIZU, PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DALIZU
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 1:634 BRIDGEFORD DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6005
Mailing Address - Country:US
Mailing Address - Phone:946-757-3393
Mailing Address - Fax:
Practice Address - Street 1:634 BRIDGEFORD DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6005
Practice Address - Country:US
Practice Address - Phone:916-757-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH59620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist