Provider Demographics
NPI:1548583271
Name:OCHOA, EDUARDO (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:
Last Name:OCHOA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 EGAN TER
Mailing Address - Street 2:
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6025
Mailing Address - Country:US
Mailing Address - Phone:201-782-0423
Mailing Address - Fax:
Practice Address - Street 1:10104 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2749
Practice Address - Country:US
Practice Address - Phone:800-511-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040184-1183500000X
NJ28RI02300600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3262360Medicaid
NY3262360Medicaid