Provider Demographics
NPI:1881290856
Name:VULETICH, MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:VULETICH
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 1:14643 ELLSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:44401-9742
Mailing Address - Country:US
Mailing Address - Phone:330-550-9188
Mailing Address - Fax:
Practice Address - Street 1:14643 ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:BERLIN CENTER
Practice Address - State:OH
Practice Address - Zip Code:44401-9742
Practice Address - Country:US
Practice Address - Phone:330-550-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH033171381835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist