Provider Demographics
NPI:1801181763
Name:NAVE, PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:NAVE
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 1:1020 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEEDLES
Mailing Address - State:CA
Mailing Address - Zip Code:92363-3809
Mailing Address - Country:US
Mailing Address - Phone:928-566-4701
Mailing Address - Fax:
Practice Address - Street 1:1020 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEEDLES
Practice Address - State:CA
Practice Address - Zip Code:92363-3809
Practice Address - Country:US
Practice Address - Phone:928-566-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21878OtherPHARMACY