Provider Demographics
NPI:1396063731
Name:FROUM, ELLEN I
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:I
Last Name:FROUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:I
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:243 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2036
Mailing Address - Country:US
Mailing Address - Phone:845-353-4949
Mailing Address - Fax:845-353-3993
Practice Address - Street 1:243 ROUTE 59
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2036
Practice Address - Country:US
Practice Address - Phone:845-353-4949
Practice Address - Fax:845-353-3993
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist