Provider Demographics
NPI:1487630679
Name:TO, EILEEN CHEN (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:CHEN
Last Name:TO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-3320
Mailing Address - Country:US
Mailing Address - Phone:718-782-7539
Mailing Address - Fax:718-782-7761
Practice Address - Street 1:106 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-3320
Practice Address - Country:US
Practice Address - Phone:718-782-7539
Practice Address - Fax:718-782-7761
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01741859Medicaid