Provider Demographics
NPI:1477854412
Name:MCILRATH, PAUL K (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:K
Last Name:MCILRATH
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 1:2750 S PRIEST DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3339
Mailing Address - Country:US
Mailing Address - Phone:480-296-9423
Mailing Address - Fax:480-929-8225
Practice Address - Street 1:2750 S PRIEST DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3339
Practice Address - Country:US
Practice Address - Phone:480-296-9423
Practice Address - Fax:480-929-8225
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist