Provider Demographics
NPI:1649479197
Name:RETTINGER, PAUL WILLIAM (PHARMD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:WILLIAM
Last Name:RETTINGER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 NICHOLS AVE
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1657
Mailing Address - Country:US
Mailing Address - Phone:731-285-6030
Mailing Address - Fax:901-682-2909
Practice Address - Street 1:2525 NICHOLS AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1657
Practice Address - Country:US
Practice Address - Phone:901-682-2886
Practice Address - Fax:901-682-2909
Is Sole Proprietor?:No
Enumeration Date:2007-07-15
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11675183500000X, 1835P0018X
MSE-09467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist