Provider Demographics
NPI:1205105905
Name:PAQUETTE, PATRICK DENNIS JR (PHARMD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:DENNIS
Last Name:PAQUETTE
Suffix:JR
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 1:1860 HAMMOCK ESTATE LN
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8113
Mailing Address - Country:US
Mailing Address - Phone:321-752-9175
Mailing Address - Fax:321-255-1390
Practice Address - Street 1:1333 N HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7022
Practice Address - Country:US
Practice Address - Phone:321-255-5954
Practice Address - Fax:321-255-1390
Is Sole Proprietor?:No
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist