Provider Demographics
NPI:1356440036
Name:EISNER, DAVA MERYL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DAVA
Middle Name:MERYL
Last Name:EISNER
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 1:4279 WEBSTER AVE.
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-2120
Mailing Address - Country:US
Mailing Address - Phone:718-652-2090
Mailing Address - Fax:718-231-9580
Practice Address - Street 1:4279 WEBSTER AVE.
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-2120
Practice Address - Country:US
Practice Address - Phone:718-652-2090
Practice Address - Fax:718-231-9580
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist