Provider Demographics
NPI:1982074852
Name:TOLENTINO, ELEANOR AGNES (RPH)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:AGNES
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ELEANOR
Other - Middle Name:AGNES
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1950 PARKVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5223
Mailing Address - Country:US
Mailing Address - Phone:831-524-2719
Mailing Address - Fax:
Practice Address - Street 1:1950 PARKVIEW CIR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5223
Practice Address - Country:US
Practice Address - Phone:831-524-2719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-04
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist