1770576498 NPI number — DR. JOSEPH MICHAEL DULA III PHARM.D.

Table of content: DR. JOSEPH MICHAEL DULA III PHARM.D. (NPI 1770576498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770576498 NPI number — DR. JOSEPH MICHAEL DULA III PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DULA
Provider First Name:
JOSEPH
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
PHARM.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770576498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6221 ACACIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLIARD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43026-6197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-374-4533
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5050 BRADENTON AVE
Provider Second Line Business Practice Location Address:
PHARMACY SYSTEMS, INC.
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43017-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-766-0101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  03-3-26856 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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