MEDICARE: MR. PAUL DAVID EISENHAUER PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH00021929	WA

General Provider Information

NPI Number	:	1477766806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL DAVID EISENHAUER PHARMACIST

Provider Business Mailing Address
First Line	:	211 LONE OAK RD
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-9520
Country	:	US
Telephone Number	:	360-423-6270
Fax Number	:

Provider Business Practice Location Address
First Line	:	3184 OCEAN BEACH HWY
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-4344
Country	:	US
Telephone Number	:	360-425-6222
Fax Number	:	360-636-6731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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