Provider Demographics
NPI:1457091092
Name:KUPIEC, EUGENE JOHN III (PHARMD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:JOHN
Last Name:KUPIEC
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 WARREN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3248
Mailing Address - Country:US
Mailing Address - Phone:315-941-0417
Mailing Address - Fax:
Practice Address - Street 1:1879 ALTAMONT AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-3851
Practice Address - Country:US
Practice Address - Phone:518-357-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist