Provider Demographics
NPI:1619977071
Name:ENG, EUGENE NMN (PHARMD, DPH)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:NMN
Last Name:ENG
Suffix:
Gender:M
Credentials:PHARMD, DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 W FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7429
Mailing Address - Country:US
Mailing Address - Phone:918-455-4769
Mailing Address - Fax:
Practice Address - Street 1:3701 S ELM PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-1804
Practice Address - Country:US
Practice Address - Phone:918-455-3902
Practice Address - Fax:918-449-9090
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist