Provider Demographics
NPI:1902069966
Name:EATON, MARYELLEN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARYELLEN
Middle Name:
Last Name:EATON
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 1:32 STATE ROUTE 82
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-4449
Mailing Address - Country:US
Mailing Address - Phone:518-851-2496
Mailing Address - Fax:518-851-2610
Practice Address - Street 1:32 STATE ROUTE 82
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-4449
Practice Address - Country:US
Practice Address - Phone:518-851-2496
Practice Address - Fax:518-851-2610
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist