Provider Demographics
NPI:1912189200
Name:COUCH, EILEEN MARIE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:MARIE
Last Name:COUCH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:MIGLIACCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9183 OLIN RD
Mailing Address - Street 2:
Mailing Address - City:MARCY
Mailing Address - State:NY
Mailing Address - Zip Code:13403-2811
Mailing Address - Country:US
Mailing Address - Phone:315-823-1047
Mailing Address - Fax:
Practice Address - Street 1:9183 OLIN RD
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403-2811
Practice Address - Country:US
Practice Address - Phone:315-823-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050787-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist