Provider Demographics
NPI:1639760176
Name:RIDGWAY, PAUL D
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:RIDGWAY
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 1:5198 FOREST RUN DR APT SUITE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1011
Mailing Address - Country:US
Mailing Address - Phone:614-406-1890
Mailing Address - Fax:
Practice Address - Street 1:5198 FOREST RUN DR APT SUITE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1011
Practice Address - Country:US
Practice Address - Phone:614-406-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03216529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty