Provider Demographics
NPI:1750693222
Name:NDI, ERIC NFORMI (RPH)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:NFORMI
Last Name:NDI
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 1:653 SQUIRE RD
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1866
Mailing Address - Country:US
Mailing Address - Phone:781-289-0651
Mailing Address - Fax:781-289-1573
Practice Address - Street 1:653 SQUIRE RD
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-1866
Practice Address - Country:US
Practice Address - Phone:781-289-0651
Practice Address - Fax:781-289-1573
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist