Provider Demographics
NPI:1356152243
Name:EBERHART, ALEX BLAKE (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:BLAKE
Last Name:EBERHART
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 1:83 VANDENBURGH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-6086
Mailing Address - Country:US
Mailing Address - Phone:518-272-1355
Mailing Address - Fax:
Practice Address - Street 1:83 VANDENBURGH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-6086
Practice Address - Country:US
Practice Address - Phone:518-272-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20-102462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist