Provider Demographics
NPI:1861676868
Name:MORONE, PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MORONE
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 1:3 SCHUYLER CT
Mailing Address - Street 2:
Mailing Address - City:WYNANTSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12198-7943
Mailing Address - Country:US
Mailing Address - Phone:518-557-6095
Mailing Address - Fax:
Practice Address - Street 1:1901 2ND AVE
Practice Address - Street 2:RITE AID #10690
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-2211
Practice Address - Country:US
Practice Address - Phone:518-271-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01317904Medicaid