Provider Demographics
NPI:1497575427
Name:KIFLOM-HALLDOW, EDEN
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:KIFLOM-HALLDOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2052
Mailing Address - Country:US
Mailing Address - Phone:904-885-8016
Mailing Address - Fax:
Practice Address - Street 1:80 SENECA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2052
Practice Address - Country:US
Practice Address - Phone:904-885-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist