Provider Demographics
NPI:1801172754
Name:MAYAN, PAUL MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:MAYAN
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 1:20 N DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4209
Mailing Address - Country:US
Mailing Address - Phone:302-730-5280
Mailing Address - Fax:302-730-5285
Practice Address - Street 1:20 N DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4209
Practice Address - Country:US
Practice Address - Phone:302-730-5280
Practice Address - Fax:302-730-5285
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDE0001856183500000X
DEA1-0001856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1801172754OtherWALGREENS