Provider Demographics
NPI:1306164058
Name:TITO, DENNIS A (RPH)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:A
Last Name:TITO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 POST RD
Mailing Address - Street 2:ROUTE 1
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-4500
Mailing Address - Country:US
Mailing Address - Phone:207-646-6894
Mailing Address - Fax:
Practice Address - Street 1:1036 POST RD
Practice Address - Street 2:ROUTE 1
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-4500
Practice Address - Country:US
Practice Address - Phone:207-646-6894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist