Healthcare Provider Details

I. General information

NPI: 1740302264
Provider Name (Legal Business Name): NEENA EAPEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NEENA EAPEN PHARMD

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WADE AVE
CATONSVILLE MD
21228-4663
US

IV. Provider business mailing address

8232 CORNERSTONE WAY
ELKRIDGE MD
21075-6294
US

V. Phone/Fax

Practice location:
  • Phone: 410-402-7696
  • Fax: 410-402-7990
Mailing address:
  • Phone: 410-799-2609
  • Fax: 410-799-2609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number15820
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: