Provider Demographics
NPI:1346590734
Name:CLEARY, PAUL EDWARD (RPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:CLEARY
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 1:2723 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-4003
Mailing Address - Country:US
Mailing Address - Phone:803-276-7668
Mailing Address - Fax:803-276-7668
Practice Address - Street 1:2723 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-4003
Practice Address - Country:US
Practice Address - Phone:803-276-7668
Practice Address - Fax:803-276-7668
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist