Provider Demographics
NPI:1154314037
Name:LOFHOLM, PAUL WILLIAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WILLIAM
Last Name:LOFHOLM
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 1:560 RALSTON LN
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:CA
Mailing Address - Zip Code:95658-9603
Mailing Address - Country:US
Mailing Address - Phone:415-845-6160
Mailing Address - Fax:
Practice Address - Street 1:1525 FRANCISCO BLVD E
Practice Address - Street 2:#1
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5539
Practice Address - Country:US
Practice Address - Phone:415-924-2480
Practice Address - Fax:415-924-1015
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist