Provider Demographics
NPI:1770648354
Name:COMBS, PAUL RUSSELL (RPH)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RUSSELL
Last Name:COMBS
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:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0120
Mailing Address - Country:US
Mailing Address - Phone:912-537-3049
Mailing Address - Fax:912-537-3040
Practice Address - Street 1:306 W 1ST ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-3369
Practice Address - Country:US
Practice Address - Phone:912-537-3049
Practice Address - Fax:912-537-3040
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist