=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578022265
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL RICHARD BARRY, JR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2019
-----------------------------------------------------
Last Update Date | 10/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 SCIENCE PARK STE 1
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06511-1989
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-497-7370
-----------------------------------------------------
Fax | 203-497-7371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 351
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06457-7023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-262-6140
-----------------------------------------------------
Fax | 203-497-7371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PCT.0006910
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------