Provider Demographics
NPI:1568784767
Name:WURTZ, PAUL A (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:WURTZ
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 1:23 SHANDON CT
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3061
Mailing Address - Country:US
Mailing Address - Phone:631-360-8146
Mailing Address - Fax:631-360-8146
Practice Address - Street 1:23 SHANDON CT
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3061
Practice Address - Country:US
Practice Address - Phone:631-360-8146
Practice Address - Fax:631-360-8146
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist