Provider Demographics
NPI:1598190126
Name:FAM, EUNICE
Entity Type:Individual
Prefix:MS
First Name:EUNICE
Middle Name:
Last Name:FAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10716 CONTINENTAL AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4725
Mailing Address - Country:US
Mailing Address - Phone:718-793-2905
Mailing Address - Fax:
Practice Address - Street 1:10716 CONTINENTAL AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4725
Practice Address - Country:US
Practice Address - Phone:718-793-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist