Provider Demographics
NPI:1477990323
Name:PAQUIN, STEPHEN ERNEST (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ERNEST
Last Name:PAQUIN
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 1:36596 UPPER CAPE CT
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-9478
Mailing Address - Country:US
Mailing Address - Phone:262-244-1234
Mailing Address - Fax:
Practice Address - Street 1:36596 UPPER CAPE CT
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-9478
Practice Address - Country:US
Practice Address - Phone:262-244-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-02
Last Update Date:2013-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112454183500000X
WI10429-40183500000X
ND3433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist