Provider Demographics
NPI:1912332321
Name:RACINE, PAUL E (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:RACINE
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 1:165 W END AVE
Mailing Address - Street 2:27J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5503
Mailing Address - Country:US
Mailing Address - Phone:646-623-7239
Mailing Address - Fax:
Practice Address - Street 1:165 W END AVE
Practice Address - Street 2:27J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5503
Practice Address - Country:US
Practice Address - Phone:646-623-7239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032905-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist