Provider Demographics
NPI:1023188992
Name:STUTES, PAUL RANDALL (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RANDALL
Last Name:STUTES
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 1:2107 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-8147
Mailing Address - Country:US
Mailing Address - Phone:337-893-5693
Mailing Address - Fax:
Practice Address - Street 1:112 E EDWARD ST
Practice Address - Street 2:
Practice Address - City:ERATH
Practice Address - State:LA
Practice Address - Zip Code:70533-4108
Practice Address - Country:US
Practice Address - Phone:337-937-8333
Practice Address - Fax:337-937-8376
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1924667Medicare UPIN