Provider Demographics
NPI:1053694265
Name:PRICE, PAUL A
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:PRICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51169 AQUA DR.
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514
Mailing Address - Country:US
Mailing Address - Phone:574-361-0218
Mailing Address - Fax:
Practice Address - Street 1:1400 CASSOPOLIS ST.
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514
Practice Address - Country:US
Practice Address - Phone:574-262-2756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013031A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist