Provider Demographics
NPI:1730548538
Name:TROVATO, PAUL (BSPHARM)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:TROVATO
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 ROSECRANS ST
Mailing Address - Street 2:PHARMACY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3115
Mailing Address - Country:US
Mailing Address - Phone:619-692-8036
Mailing Address - Fax:619-692-8034
Practice Address - Street 1:3851 ROSECRANS ST
Practice Address - Street 2:PHARMACY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8036
Practice Address - Fax:619-692-8034
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist