Provider Demographics
NPI:1851805725
Name:KASAEV, EDEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDEN
Middle Name:
Last Name:KASAEV
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 1:8054 KENT ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1545
Mailing Address - Country:US
Mailing Address - Phone:347-681-5191
Mailing Address - Fax:
Practice Address - Street 1:4166 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3020
Practice Address - Country:US
Practice Address - Phone:718-881-5800
Practice Address - Fax:718-881-5803
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty