Provider Demographics
NPI:1982094546
Name:DEEGAN, ELISE (CPHT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:DEEGAN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILLOW PARK CTR
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-1001
Mailing Address - Country:US
Mailing Address - Phone:631-962-0271
Mailing Address - Fax:631-962-1471
Practice Address - Street 1:100 WILLOW PARK CTR
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-1001
Practice Address - Country:US
Practice Address - Phone:631-962-0271
Practice Address - Fax:631-962-1471
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician