Provider Demographics
NPI:1093250219
Name:RHEM, EBONY (RPH)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:RHEM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BENTLEY RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1703
Mailing Address - Country:US
Mailing Address - Phone:718-548-5884
Mailing Address - Fax:
Practice Address - Street 1:5564 BROADWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5296
Practice Address - Country:US
Practice Address - Phone:718-548-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065114183500000X
MAPH237184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist