Basic Information
| Provider Information | |||||||||
| NPI: | 1356712145 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAUL | ||||||||
| FirstName: | NARIN | ||||||||
| MiddleName: | CHAMROEUN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PHARM D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018522103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789379700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 161 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018522103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815934805 | ||||||||
| FaxNumber: | 7815935275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2015 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH27603 | MA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.