=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033083076
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL V TIROTTO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2025
-----------------------------------------------------
Last Update Date | 10/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2745 MCKEAN ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19145-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-317-5898
-----------------------------------------------------
Fax | 215-334-4784
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 326 NEWTON CT
-----------------------------------------------------
City | HADDON TOWNSHIP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08107-1073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-551-9485
-----------------------------------------------------
Fax | 215-468-7189
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP034892L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------