Active NPI
Alyce Marie Petrutiu
- Pharmacist
- Pacific Grove, CA
National Provider Identifier
1619201787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 40190
- Practice address
- 133 15TH St
Pacific Grove, CA 93950-2746 - Phone
- (831) 373-1225
- NPI assigned
- Sep 23, 2009
- Last updated
- Feb 4, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 40190 | CA | Primary |
| Pharmacist | 183500000X | 9309 | NV |
Addresses
Primary practice location
133 15TH St
Pacific Grove, CA 93950-2746
Mailing address
410 19TH St
Pacific Grove, CA 93950-4102
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40190 | CA | MD | Pharmacist |
| 9309 | NV | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cap RX Inc | Past | Accepting new patients | |
| Cap RX Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423008000000",
"number": "1619201787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 19TH ST",
"city": "PACIFIC GROVE",
"state": "CA",
"postal_code": "939504102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "133 15TH ST",
"city": "PACIFIC GROVE",
"state": "CA",
"postal_code": "939502746",
"telephone_number": "831-373-1225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRUTIU",
"first_name": "ALYCE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-23",
"last_updated": "2015-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "40190",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NV",
"license": "9309",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pacific Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.