Provider Demographics
NPI:1821351776
Name:STOREY, PAUL F (BSPHARM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:STOREY
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2408
Mailing Address - Country:US
Mailing Address - Phone:509-452-6567
Mailing Address - Fax:
Practice Address - Street 1:1610 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2408
Practice Address - Country:US
Practice Address - Phone:509-452-6567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60150717183500000X
NV10095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist