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
- 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 and National Provider Directory roles.
-
- Long Term Care Pharmacy
- Pacific Grove, CA
- NPI 1104458843
-
- Community/Retail Pharmacy
- Pacific Grove, CA
- NPI 1942393376
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.