Provider Demographics
NPI:1760663801
Name:GREW, PAUL J (RPH)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:J
Last Name:GREW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6725 CORTLAND DR
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-9651
Mailing Address - Country:US
Mailing Address - Phone:585-820-1344
Mailing Address - Fax:716-631-2961
Practice Address - Street 1:6725 CORTLAND DR
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-9651
Practice Address - Country:US
Practice Address - Phone:585-820-1344
Practice Address - Fax:716-631-2961
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist