Provider Demographics
NPI:1851624704
Name:CRISAFULLI, EUGENE JOSEPH (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:JOSEPH
Last Name:CRISAFULLI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-0103
Mailing Address - Country:US
Mailing Address - Phone:402-216-4055
Mailing Address - Fax:402-919-9030
Practice Address - Street 1:15519JACKSON CIRCLE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154
Practice Address - Country:US
Practice Address - Phone:402-216-4055
Practice Address - Fax:402-919-9030
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist