Provider Demographics
NPI:1548605207
Name:STREET, PARIS JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:PARIS
Middle Name:
Last Name:STREET
Suffix:JR
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 1:638 HARALSON DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5365
Mailing Address - Country:US
Mailing Address - Phone:770-596-9322
Mailing Address - Fax:770-225-1889
Practice Address - Street 1:638 HARALSON DR SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-5365
Practice Address - Country:US
Practice Address - Phone:770-596-9322
Practice Address - Fax:770-225-1889
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist