Provider Demographics
NPI:1306178652
Name:DOBER, ELEANOR M (RPH)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:M
Last Name:DOBER
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 1:3652 BURTON ST
Mailing Address - Street 2:
Mailing Address - City:SHERRILLS FORD
Mailing Address - State:NC
Mailing Address - Zip Code:28673-9800
Mailing Address - Country:US
Mailing Address - Phone:315-771-4112
Mailing Address - Fax:
Practice Address - Street 1:29 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GOUVERNEUR
Practice Address - State:NY
Practice Address - Zip Code:13642-1401
Practice Address - Country:US
Practice Address - Phone:315-287-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist