Provider Demographics
NPI:1275812711
Name:CORRADO, PAUL MICHAEL SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MICHAEL
Last Name:CORRADO
Suffix:SR
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 1:352 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:ME
Mailing Address - Zip Code:04427-3272
Mailing Address - Country:US
Mailing Address - Phone:207-518-3356
Mailing Address - Fax:
Practice Address - Street 1:352 MAIN ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:ME
Practice Address - Zip Code:04427-3272
Practice Address - Country:US
Practice Address - Phone:207-518-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPH4111183500000X
NH1996183500000X
FL15893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPH4111OtherPHARMACIST LICENSE