Provider Demographics
NPI:1194025122
Name:EID, NERMINE
Entity Type:Individual
Prefix:
First Name:NERMINE
Middle Name:
Last Name:EID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21181 NEWPORT COAST DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1123
Mailing Address - Country:US
Mailing Address - Phone:949-718-4986
Mailing Address - Fax:949-718-6258
Practice Address - Street 1:21181 NEWPORT COAST DR
Practice Address - Street 2:
Practice Address - City:NEWPORT COAST
Practice Address - State:CA
Practice Address - Zip Code:92657-1123
Practice Address - Country:US
Practice Address - Phone:949-718-4986
Practice Address - Fax:949-718-6258
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist