=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942570205
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. PAUL W EK
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2012
-----------------------------------------------------
Last Update Date | 01/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10920 RANDOLPH ST
-----------------------------------------------------
City | CROWN POINT
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46307-7753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-661-8117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 STILLWATER CT
-----------------------------------------------------
City | HEBRON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46341-7216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-988-3534
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 26022350A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051-288418
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------