Healthcare Provider Details

I. General information

NPI: 1225791254
Provider Name (Legal Business Name): GERTRAUD NDEDI EYONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2021
Last Update Date: 10/17/2021
Certification Date: 10/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 N SUSQUEHANNA TRL
SELINSGROVE PA
17870-7766
US

IV. Provider business mailing address

980 N SUSQUEHANNA TRL
SELINSGROVE PA
17870-7766
US

V. Phone/Fax

Practice location:
  • Phone: 570-374-1230
  • Fax:
Mailing address:
  • Phone: 570-374-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP455317
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: