Provider Demographics
NPI:1174889968
Name:PAULSON, RONALD N (RPH)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:N
Last Name:PAULSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 EDINBURGH RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-7284
Mailing Address - Country:US
Mailing Address - Phone:920-288-0094
Mailing Address - Fax:
Practice Address - Street 1:3480 EDINBURGH RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-7284
Practice Address - Country:US
Practice Address - Phone:920-288-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI109291835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric