Healthcare Provider Details

I. General information

NPI: 1760690333
Provider Name (Legal Business Name): PAUL F NUNAMAKER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 5TH & GRIZZLY MANIILAQ ASSOCIATION
KOTZEBUE AK
99752
US

IV. Provider business mailing address

66200 BROOM RD
CAMBRIDGE OH
43725-9631
US

V. Phone/Fax

Practice location:
  • Phone: 907-442-7182
  • Fax:
Mailing address:
  • Phone: 740-439-2019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1374
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-19731
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: