Provider Demographics
NPI:1437795259
Name:VILLARET, PAUL CHARLES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CHARLES
Last Name:VILLARET
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 1:1855 N GROVELAND PL
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4275
Mailing Address - Country:US
Mailing Address - Phone:702-335-2626
Mailing Address - Fax:
Practice Address - Street 1:1855 N GROVELAND PL
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4275
Practice Address - Country:US
Practice Address - Phone:702-335-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist