Provider Demographics
NPI:1245558287
Name:BONTORNO, EILEEN S
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:S
Last Name:BONTORNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:S
Other - Last Name:ROSSWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:210 N FRANKLIN ST
Mailing Address - Street 2:PO BOX 696
Mailing Address - City:WATKINS GLEN
Mailing Address - State:NY
Mailing Address - Zip Code:14891-1224
Mailing Address - Country:US
Mailing Address - Phone:607-535-4999
Mailing Address - Fax:518-463-4514
Practice Address - Street 1:210 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1224
Practice Address - Country:US
Practice Address - Phone:607-535-4999
Practice Address - Fax:518-463-4514
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030593183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy