Provider Demographics
NPI:1295914745
Name:EMERY, PAUL EDWARD
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:EDWARD
Last Name:EMERY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:EDWARD
Other - Last Name:EMERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:189 ST MARYS AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1730
Mailing Address - Country:US
Mailing Address - Phone:315-853-4364
Mailing Address - Fax:866-840-3873
Practice Address - Street 1:189 ST MARYS AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1730
Practice Address - Country:US
Practice Address - Phone:315-853-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist