Provider Demographics
NPI:1811559339
Name:MOURIS, PAUL C (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:C
Last Name:MOURIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 BLOOMINGDALE RD STE 406
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1511
Mailing Address - Country:US
Mailing Address - Phone:914-682-2826
Mailing Address - Fax:
Practice Address - Street 1:222 BLOOMINGDALE RD STE 406
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1511
Practice Address - Country:US
Practice Address - Phone:914-682-2826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-04
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0009959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist