Provider Demographics
NPI:1447522271
Name:PAUL, GARY CHARLES (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:CHARLES
Last Name:PAUL
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 1:2414 335TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-8070
Mailing Address - Country:US
Mailing Address - Phone:712-310-9136
Mailing Address - Fax:
Practice Address - Street 1:2414 335TH ST
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555-8070
Practice Address - Country:US
Practice Address - Phone:712-310-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17473183500000X
NE12293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist