Provider Demographics
NPI:1225490485
Name:PAUL, PATRICK EVANS
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:EVANS
Last Name:PAUL
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 1:19 GLENCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4908
Mailing Address - Country:US
Mailing Address - Phone:617-840-9653
Mailing Address - Fax:
Practice Address - Street 1:1377 HYDE PARK AVE
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2752
Practice Address - Country:US
Practice Address - Phone:617-364-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH235360183500000X
RIRPH05552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist