Provider Demographics
NPI:1720209364
Name:PAUL, JUDITH CAROL (RPH)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CAROL
Last Name:PAUL
Suffix:
Gender:F
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:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-0507
Mailing Address - Country:US
Mailing Address - Phone:313-331-0903
Mailing Address - Fax:
Practice Address - Street 1:932 TROMBLEY RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1860
Practice Address - Country:US
Practice Address - Phone:313-331-0903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist