Healthcare Provider Details

I. General information

NPI: 1205104643
Provider Name (Legal Business Name): PAUL CAUDILL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 PATTERSON AVE
HENRICO VA
23238-5028
US

IV. Provider business mailing address

11120 PATTERSON AVE
HENRICO VA
23238-5028
US

V. Phone/Fax

Practice location:
  • Phone: 804-740-0238
  • Fax:
Mailing address:
  • Phone: 804-740-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202208442
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: