Provider Demographics
NPI:1205826831
Name:FOLDEN, PAUL DONOVAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DONOVAN
Last Name:FOLDEN
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 1:619 DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4325
Mailing Address - Country:US
Mailing Address - Phone:701-642-6223
Mailing Address - Fax:701-642-8839
Practice Address - Street 1:619 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4325
Practice Address - Country:US
Practice Address - Phone:701-642-6223
Practice Address - Fax:701-642-8839
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0012714183500000X
NDRPH3952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN701260XMedicaid
ND20159Medicaid
ND20159Medicaid