Provider Demographics
NPI:1447285283
Name:BARBOUR, PAUL JORDAN (PHARMD, MS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JORDAN
Last Name:BARBOUR
Suffix:
Gender:M
Credentials:PHARMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SPRUCE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1460
Mailing Address - Country:US
Mailing Address - Phone:401-949-4459
Mailing Address - Fax:
Practice Address - Street 1:830 CHALKSTONE AVENUE
Practice Address - Street 2:PHARMACY SERVICE (119)
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4799
Practice Address - Country:US
Practice Address - Phone:401-457-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO121941835P1200X
MA178741835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy