Healthcare Provider Details

I. General information

NPI: 1679560627
Provider Name (Legal Business Name): TUTTLE'S PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

Provider Other Name: TUTTLE'S DOYLE PARK PHARMACY

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date: TUTTLE'S PHARMACY INC. 1220 SONOMA AVE SANTA ROSA CA 95405 1220 SONOMA AVE SANTA ROSA CA 95405
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 SONOMA AVE
SANTA ROSA CA
95405-6621
US

IV. Provider business mailing address

1220 SONOMA AVE
SANTA ROSA CA
95405-6621
US

V. Phone/Fax

Practice location:
  • Phone: 707-546-9090
  • Fax: 707-526-5912
Mailing address:
  • Phone: 707-546-9090
  • Fax: 707-526-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyX
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH32030
License Number StateCA
# 2
Primary TaxonomyX
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH18178
License Number StateCA
# 3
Primary TaxonomyX
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH39445
License Number StateCA

VIII. Authorized Official

Name: ROBERT JOHN PELLEGRINI
Title or Position: OWNER/PHARMACIST IN CHARGE
Credential: RPH
Phone: 707-546-9090