Provider Demographics
NPI:1861723843
Name:ALBAUGH, PAUL DAVID (PHARMD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:ALBAUGH
Suffix:
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 1:308 CHAMBLEE BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6734
Mailing Address - Country:US
Mailing Address - Phone:517-410-9943
Mailing Address - Fax:
Practice Address - Street 1:2014 WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1037
Practice Address - Country:US
Practice Address - Phone:864-214-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031034183500000X
SC13813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist