Provider Demographics
NPI:1609487255
Name:ROXO, PAULO L
Entity Type:Individual
Prefix:
First Name:PAULO
Middle Name:L
Last Name:ROXO
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 1:54 EAST ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-3407
Mailing Address - Country:US
Mailing Address - Phone:413-547-8128
Mailing Address - Fax:413-547-8013
Practice Address - Street 1:54 EAST ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-3407
Practice Address - Country:US
Practice Address - Phone:413-547-8128
Practice Address - Fax:413-547-8013
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist