Provider Demographics
NPI:1659323723
Name:PAULSON, MARY JANETTE (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JANETTE
Last Name:PAULSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5852 HIGHWAY T38 N
Mailing Address - Street 2:PO BOX 476
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-7624
Mailing Address - Country:US
Mailing Address - Phone:641-236-5762
Mailing Address - Fax:
Practice Address - Street 1:5852 HIGHWAY T38 N
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-7624
Practice Address - Country:US
Practice Address - Phone:641-236-5762
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist