Provider Demographics
NPI:1316455470
Name:JOSEPH, PAUL RENCIT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RENCIT
Last Name:JOSEPH
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 1:3621 SE 177TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8219
Mailing Address - Country:US
Mailing Address - Phone:360-910-2301
Mailing Address - Fax:
Practice Address - Street 1:2521 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-4343
Practice Address - Country:US
Practice Address - Phone:541-883-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0016386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist