Provider Demographics
NPI:1861867418
Name:PARADISE, GERARD (RPH)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:PARADISE
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 1:2850 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315
Mailing Address - Country:US
Mailing Address - Phone:717-764-3382
Mailing Address - Fax:717-764-4681
Practice Address - Street 1:2850 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-4602
Practice Address - Country:US
Practice Address - Phone:717-764-3382
Practice Address - Fax:717-764-4681
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032460L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist