Provider Demographics
NPI:1164702650
Name:DO, EUNHA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EUNHA
Middle Name:
Last Name:DO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:DO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:115 E HAWKINS PKWY
Mailing Address - Street 2:APT 621
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-3614
Mailing Address - Country:US
Mailing Address - Phone:706-614-7507
Mailing Address - Fax:
Practice Address - Street 1:115 E HAWKINS PKWY
Practice Address - Street 2:APT 621
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-3614
Practice Address - Country:US
Practice Address - Phone:706-614-7507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47860183500000X
GARPH024811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist