Provider Demographics
NPI:1578022265
Name:BARRY, JR., PAUL RICHARD
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RICHARD
Last Name:BARRY, JR.
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-7023
Mailing Address - Country:US
Mailing Address - Phone:860-262-6140
Mailing Address - Fax:203-497-7371
Practice Address - Street 1:5 SCIENCE PARK STE 1
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1989
Practice Address - Country:US
Practice Address - Phone:203-497-7370
Practice Address - Fax:203-497-7371
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0006910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist