Healthcare Provider Details

I. General information

NPI: 1992115729
Provider Name (Legal Business Name): ELEONORA AMCHESLAVSKY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 VIA LA CUMBRE
GREENBRAE CA
94904-1337
US

IV. Provider business mailing address

370 VIA LA CUMBRE
GREENBRAE CA
94904-1337
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-9216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH52771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: