Provider Demographics
NPI:1164778551
Name:AUTLER, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:AUTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:
Mailing Address - City:BRIDGEHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11932-0409
Mailing Address - Country:US
Mailing Address - Phone:631-537-0235
Mailing Address - Fax:
Practice Address - Street 1:200 BRIDGEHAMPTON COMMONS
Practice Address - Street 2:RITE AID
Practice Address - City:BRIDGEHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11932-0409
Practice Address - Country:US
Practice Address - Phone:631-537-0235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist