Provider Demographics
NPI:1891313847
Name:EIREW, GARY (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:EIREW
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 1:28108 CHAMPIONSHIP DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-6414
Mailing Address - Country:US
Mailing Address - Phone:951-259-3768
Mailing Address - Fax:
Practice Address - Street 1:1186 CALIMESA BLVD
Practice Address - Street 2:
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-1509
Practice Address - Country:US
Practice Address - Phone:909-795-1147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH39536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist