Provider Demographics
NPI:1982102638
Name:EINSIDLER, ELLEN JOYCE (RPH)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:JOYCE
Last Name:EINSIDLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 ACUSHNET AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02746-2018
Mailing Address - Country:US
Mailing Address - Phone:508-984-5402
Mailing Address - Fax:
Practice Address - Street 1:1207 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02746-2018
Practice Address - Country:US
Practice Address - Phone:508-984-5402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05771183500000X
MAPH237156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist