Provider Demographics
NPI:1255685129
Name:GREEDER, PAUL RAYMOND (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RAYMOND
Last Name:GREEDER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 COULEE RD
Mailing Address - Street 2:T-1235
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-2183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 COULEE RD
Practice Address - Street 2:T-1235
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-2183
Practice Address - Country:US
Practice Address - Phone:715-381-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13414-40183500000X
MN117638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist