Provider Demographics
NPI:1679528780
Name:DIBIASE, PAUL JOSEPH JR (RPH, CDOE)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:DIBIASE
Suffix:JR
Gender:M
Credentials:RPH, CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 BUTTONWOODS AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7541
Mailing Address - Country:US
Mailing Address - Phone:401-739-4330
Mailing Address - Fax:401-732-8316
Practice Address - Street 1:198 BUTTONWOODS AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-7541
Practice Address - Country:US
Practice Address - Phone:401-739-4330
Practice Address - Fax:401-732-8316
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI3613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI405280Medicare UPIN
RI20775-1Medicare UPIN
RI63-00106Medicare UPIN