Healthcare Provider Details

I. General information

NPI: 1881148047
Provider Name (Legal Business Name): PAUL MEOLA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 WOODBRIDGE CENTER WAY
EDGEWOOD MD
21040-3836
US

IV. Provider business mailing address

7733 JUSTIN CT N
ST PETERSBURG FL
33709-1249
US

V. Phone/Fax

Practice location:
  • Phone: 410-676-6100
  • Fax:
Mailing address:
  • Phone: 727-459-4561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24330
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: