Provider Demographics
NPI:1821687294
Name:ALFRED, EBONY N
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:N
Last Name:ALFRED
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 1:3590 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4614
Mailing Address - Country:US
Mailing Address - Phone:409-813-8452
Mailing Address - Fax:409-980-5883
Practice Address - Street 1:3590 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4614
Practice Address - Country:US
Practice Address - Phone:409-813-8452
Practice Address - Fax:409-980-5883
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX225954OtherPHARMACY TECHNICIAN LICENSE