Healthcare Provider Details

I. General information

NPI: 1730548538
Provider Name (Legal Business Name): PAUL TROVATO B.S.PHARM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROSECRANS ST PHARMACY
SAN DIEGO CA
92110-3115
US

IV. Provider business mailing address

3851 ROSECRANS ST PHARMACY
SAN DIEGO CA
92110-3115
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-8036
  • Fax: 619-692-8034
Mailing address:
  • Phone: 619-692-8036
  • Fax: 619-692-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: