Provider Demographics
NPI:1336659317
Name:NOLAN, PAUL JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JAMES
Last Name:NOLAN
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 1:515 STEWART DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3417
Mailing Address - Country:US
Mailing Address - Phone:315-214-6457
Mailing Address - Fax:315-452-0048
Practice Address - Street 1:515 STEWART DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-3417
Practice Address - Country:US
Practice Address - Phone:315-214-6457
Practice Address - Fax:315-452-0048
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059299I183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist