Provider Demographics
NPI:1578845251
Name:ZVENIGORODSLY, ELEONORA Y (RPH)
Entity Type:Individual
Prefix:
First Name:ELEONORA
Middle Name:Y
Last Name:ZVENIGORODSLY
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 1:162 LARKSPUR PL
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2704
Mailing Address - Country:US
Mailing Address - Phone:215-676-1948
Mailing Address - Fax:215-673-0982
Practice Address - Street 1:12050 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2108
Practice Address - Country:US
Practice Address - Phone:215-673-0937
Practice Address - Fax:215-673-0982
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044210L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist