Provider Demographics
NPI:1457684078
Name:PERON, EDDIE (PHARM D)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:PERON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 STEWART PL
Mailing Address - Street 2:APT #C
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4383
Mailing Address - Country:US
Mailing Address - Phone:201-458-4308
Mailing Address - Fax:
Practice Address - Street 1:5706 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1230
Practice Address - Country:US
Practice Address - Phone:201-869-8054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02923100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist