Provider Demographics
NPI:1679783112
Name:MEDICO, PAUL F (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:F
Last Name:MEDICO
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 1:114 ANDREW LN
Mailing Address - Street 2:
Mailing Address - City:HANSON
Mailing Address - State:MA
Mailing Address - Zip Code:02341-1364
Mailing Address - Country:US
Mailing Address - Phone:781-294-7589
Mailing Address - Fax:
Practice Address - Street 1:476 LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:HANSON
Practice Address - State:MA
Practice Address - Zip Code:02341
Practice Address - Country:US
Practice Address - Phone:781-293-0561
Practice Address - Fax:781-293-0529
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist