Healthcare Provider Details

I. General information

NPI: 1275812711
Provider Name (Legal Business Name): PAUL MICHAEL CORRADO SR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 MAIN ST
CORINTH ME
04427-3272
US

IV. Provider business mailing address

352 MAIN ST
CORINTH ME
04427-3272
US

V. Phone/Fax

Practice location:
  • Phone: 207-518-3356
  • Fax:
Mailing address:
  • Phone: 207-518-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH4111
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1996
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: