Provider Demographics
NPI:1235131004
Name:CADY, PAUL S (RPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:CADY
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3427
Mailing Address - Country:US
Mailing Address - Phone:208-234-2656
Mailing Address - Fax:208-282-4482
Practice Address - Street 1:13 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3427
Practice Address - Country:US
Practice Address - Phone:208-234-2656
Practice Address - Fax:208-282-4482
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID55691835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy