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NPI Code Detail

MEDICARE: PAUL WILLIAM SPRINGBORN RPH

MEDICARE: PAUL WILLIAM SPRINGBORN RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P1300XPsychiatric Pharmacist12932-040WI

General Provider Information

NPI Number : 1972501070
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL WILLIAM SPRINGBORN RPH
Provider Business Mailing Address
First Line : 682 INDIAN PATH RD
Second Line :
City : GRAYSLAKE
State : IL
Zip : 60030-3517
Country : US
Telephone Number : 847-543-0970
Fax Number : 262-687-2686
Provider Business Practice Location Address
First Line : 1320 WISCONSIN AVE
Second Line :
City : RACINE
State : WI
Zip : 53403-1978
Country : US
Telephone Number : 262-687-2206
Fax Number : 262-687-2686
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 07/08/2007

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