Provider Demographics
NPI:1316351802
Name:VITKUS, PAUL E (RPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:VITKUS
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 1:4185 RIVERHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-2189
Mailing Address - Country:US
Mailing Address - Phone:775-770-3220
Mailing Address - Fax:775-770-3640
Practice Address - Street 1:4185 RIVERHAVEN DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-2189
Practice Address - Country:US
Practice Address - Phone:775-770-3220
Practice Address - Fax:775-770-3640
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist