Provider Demographics
NPI:1780093138
Name:DULATRE, PEPITO DE VERA (RPH)
Entity type:Individual
Prefix:
First Name:PEPITO
Middle Name:DE VERA
Last Name:DULATRE
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 1:248 S HOBART BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5208
Mailing Address - Country:US
Mailing Address - Phone:805-824-2199
Mailing Address - Fax:
Practice Address - Street 1:248 S HOBART BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5208
Practice Address - Country:US
Practice Address - Phone:805-824-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH70443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH70443OtherCALIFORNIA REGISTERED PHARMACIST