Provider Demographics
NPI:1215219514
Name:PAUL, NEVIL
Entity type:Individual
Prefix:
First Name:NEVIL
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 JOHNS LAKE RD
Mailing Address - Street 2:APT # 316
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6655
Mailing Address - Country:US
Mailing Address - Phone:321-948-4577
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTHERN BREEZE DR
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-5654
Practice Address - Country:US
Practice Address - Phone:352-241-4390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist