Provider Demographics
NPI:1538361407
Name:TUBOLINO, ERIK MICHAEL (PHARMD,CGP)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:MICHAEL
Last Name:TUBOLINO
Suffix:
Gender:M
Credentials:PHARMD,CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1229
Mailing Address - Country:US
Mailing Address - Phone:315-376-5082
Mailing Address - Fax:315-376-5310
Practice Address - Street 1:7785 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-3106
Practice Address - Country:US
Practice Address - Phone:315-376-5082
Practice Address - Fax:315-376-5310
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051475183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric