Provider Demographics
NPI:1194006874
Name:JOHN, PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:JOHN
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 1:1315 W PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1038
Mailing Address - Country:US
Mailing Address - Phone:757-623-6115
Mailing Address - Fax:
Practice Address - Street 1:810 W 21ST ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1514
Practice Address - Country:US
Practice Address - Phone:757-623-7213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist