Provider Demographics
NPI:1154644508
Name:DEGEN, PAUL JAMES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAMES
Last Name:DEGEN
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 1:9800 HEALTH CARE LN
Mailing Address - Street 2:MAIL STOP MN006-E500
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-4542
Mailing Address - Country:US
Mailing Address - Phone:763-913-6303
Mailing Address - Fax:
Practice Address - Street 1:9800 HEALTH CARE LN
Practice Address - Street 2:MAIL STOP MN006-E500
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-4542
Practice Address - Country:US
Practice Address - Phone:763-913-6303
Practice Address - Fax:763-913-6303
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1801126214OtherNPI
MN2429959OtherNCPDP
FP1789532OtherDEA