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General NPI Number Information
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NPI Number | 1326056391
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Entity Type | Organization
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Legal Business Name | PAULS PHARMACY INC
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 12/08/2008
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Provider Practice Location Address
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Address Line | 803 LINCOLN AVE
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City | HOLLAND
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State | MI
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Zip | 49423
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Country | US
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Telephone | 616-396-5233
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Fax | 616-396-4270
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Provider Business Mailing Address
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Address Line | 803 LINCOLN AVE
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City | HOLLAND
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State | MI
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Zip | 49423
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Country | US
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Telephone | 616-396-5233
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Fax | 616-396-4270
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES L BUSSIS
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Credential | RPH
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Telephone | 616-396-5233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 5301000422
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301000422
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License Number State | MI
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