Provider Demographics
NPI:1265674097
Name:PAULS PHARMACY INC
Entity Type:Organization
Organization Name:PAULS PHARMACY INC
Other - Org Name:PAULS LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-426-5033
Mailing Address - Street 1:4111 N ST JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720
Mailing Address - Country:US
Mailing Address - Phone:812-426-5033
Mailing Address - Fax:812-402-8920
Practice Address - Street 1:4111 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47720-1206
Practice Address - Country:US
Practice Address - Phone:812-426-5033
Practice Address - Fax:812-402-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006285A3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135286OtherPK