Provider Demographics
NPI:1811201627
Name:FAIS, EUGENE (RPH)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:FAIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E 72ND ST
Mailing Address - Street 2:APT. B-307
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4753
Mailing Address - Country:US
Mailing Address - Phone:212-585-1707
Mailing Address - Fax:212-585-1707
Practice Address - Street 1:1449 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3002
Practice Address - Country:US
Practice Address - Phone:212-535-7100
Practice Address - Fax:212-535-7101
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01275200183500000X
NY054280-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist