Provider Demographics
NPI:1659661429
Name:KEO, EANG B (RPH)
Entity type:Individual
Prefix:MR
First Name:EANG
Middle Name:B
Last Name:KEO
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 1:3 COBBLE CT
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1593
Mailing Address - Country:US
Mailing Address - Phone:860-404-3041
Mailing Address - Fax:
Practice Address - Street 1:900 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-2219
Practice Address - Country:US
Practice Address - Phone:860-829-0740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist