Healthcare Provider Details

I. General information

NPI: 1255517553
Provider Name (Legal Business Name): EULALIA Y RALPH R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2348 ROUTE 19 N
WARSAW NY
14569-9356
US

IV. Provider business mailing address

2348 ROUTE 19 N
WARSAW NY
14569-9356
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-0880
  • Fax: 585-786-0882
Mailing address:
  • Phone: 585-786-0880
  • Fax: 585-786-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038483-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: