=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760663801
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL J GREW RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2007
-----------------------------------------------------
Last Update Date | 11/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6725 CORTLAND DR
-----------------------------------------------------
City | NORTH TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14120-9651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-820-1344
-----------------------------------------------------
Fax | 716-631-2961
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6725 CORTLAND DR
-----------------------------------------------------
City | NORTH TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14120-9651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-820-1344
-----------------------------------------------------
Fax | 716-631-2961
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 046222
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------