Provider Demographics
NPI:1447564760
Name:CANNON, PAUL RICHARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RICHARD
Last Name:CANNON
Suffix:
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 1:225 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-2054
Mailing Address - Country:US
Mailing Address - Phone:207-474-2525
Mailing Address - Fax:207-474-8987
Practice Address - Street 1:225 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-2054
Practice Address - Country:US
Practice Address - Phone:207-474-2525
Practice Address - Fax:207-474-8987
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist