Provider Demographics
NPI:1902117674
Name:FRIEDMAN, EUGENE N (RPH)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:N
Last Name:FRIEDMAN
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 1:504 BICYCLE PATH
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3433
Mailing Address - Country:US
Mailing Address - Phone:631-476-1712
Mailing Address - Fax:
Practice Address - Street 1:504 BICYCLE PATH
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3433
Practice Address - Country:US
Practice Address - Phone:631-476-1712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist