Provider Demographics
NPI:1578257390
Name:NYASANI, EUNICE KERUBO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EUNICE
Middle Name:KERUBO
Last Name:NYASANI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:EUNICE
Other - Middle Name:K
Other - Last Name:NYASANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1640 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-2162
Mailing Address - Country:US
Mailing Address - Phone:978-249-9132
Mailing Address - Fax:
Practice Address - Street 1:1640 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-2162
Practice Address - Country:US
Practice Address - Phone:978-249-9132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH241415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist