Provider Demographics
NPI:1093031833
Name:EISSENS, PAUL DWAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DWAYNE
Last Name:EISSENS
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 1:811 N BROWN ST
Mailing Address - Street 2:
Mailing Address - City:CHADBOURN
Mailing Address - State:NC
Mailing Address - Zip Code:28431-1309
Mailing Address - Country:US
Mailing Address - Phone:910-654-5572
Mailing Address - Fax:910-654-5599
Practice Address - Street 1:811 N BROWN ST
Practice Address - Street 2:
Practice Address - City:CHADBOURN
Practice Address - State:NC
Practice Address - Zip Code:28431-1309
Practice Address - Country:US
Practice Address - Phone:910-654-5572
Practice Address - Fax:910-654-5599
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6774183500000X
SC9630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist