Provider Demographics
NPI:1184035370
Name:PAUL, ANNMARY
Entity Type:Individual
Prefix:
First Name:ANNMARY
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3228
Mailing Address - Country:US
Mailing Address - Phone:201-781-0461
Mailing Address - Fax:
Practice Address - Street 1:406 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-4312
Practice Address - Country:US
Practice Address - Phone:201-384-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-10
Last Update Date:2014-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03617400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist