Provider Demographics
NPI:1952181760
Name:FLANAGAN, PAUL EDWIN (RPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWIN
Last Name:FLANAGAN
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 1:429 GRANDLIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9107
Mailing Address - Country:US
Mailing Address - Phone:614-868-0184
Mailing Address - Fax:
Practice Address - Street 1:8300 MEIJER DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7400
Practice Address - Country:US
Practice Address - Phone:614-920-9721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03443086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist