Provider Demographics
NPI:1629721170
Name:EAPEN, NIOBE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NIOBE
Middle Name:
Last Name:EAPEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 N COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-3793
Mailing Address - Country:US
Mailing Address - Phone:817-276-5370
Mailing Address - Fax:817-276-5375
Practice Address - Street 1:2755 N COLLINS ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-3793
Practice Address - Country:US
Practice Address - Phone:817-276-5370
Practice Address - Fax:817-276-5375
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist