Provider Demographics
NPI:1710161401
Name:FLATLEY, PAUL R (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:FLATLEY
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 1:3049 RT 50
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8574
Mailing Address - Country:US
Mailing Address - Phone:518-583-3697
Mailing Address - Fax:518-583-3110
Practice Address - Street 1:3049 ROUTE 50
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-583-3697
Practice Address - Fax:518-583-3110
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist