Provider Demographics
NPI:1669787875
Name:DER, PAUL ANTHONY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTHONY
Last Name:DER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 SLOANE AVE
Mailing Address - Street 2:APARTMENT 802
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3163
Mailing Address - Country:US
Mailing Address - Phone:330-221-1551
Mailing Address - Fax:216-265-4483
Practice Address - Street 1:12301 SNOW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1002
Practice Address - Country:US
Practice Address - Phone:216-265-4466
Practice Address - Fax:216-265-4483
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist