Provider Demographics
NPI:1861259194
Name:EISAI PATIENT SUPPORT PHARMACY
Entity type:Organization
Organization Name:EISAI PATIENT SUPPORT PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:KWIATKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-502-7015
Mailing Address - Street 1:2730 EDMONDS LN STE 400-A
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6731
Mailing Address - Country:US
Mailing Address - Phone:866-613-4724
Mailing Address - Fax:855-246-5192
Practice Address - Street 1:2730 EDMONDS LN STE 400-A
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-6731
Practice Address - Country:US
Practice Address - Phone:866-613-4724
Practice Address - Fax:855-246-5192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SONEXUS HEALTH PHARMACY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-04
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35268OtherBOARD OF PHARMACY LICENSE NUMBER