Provider Demographics
NPI:1851720718
Name:AVRAHAMI, ELI (RPH)
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:
Last Name:AVRAHAMI
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 1:1320 W BURNHAM ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3248
Mailing Address - Country:US
Mailing Address - Phone:414-383-4111
Mailing Address - Fax:
Practice Address - Street 1:1320 W BURNHAM ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3248
Practice Address - Country:US
Practice Address - Phone:414-339-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15777-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist