Healthcare Provider Details

I. General information

NPI: 1841361318
Provider Name (Legal Business Name): EILEEN B HERBECK R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 4TH ST
LONGVIEW TX
75601-4717
US

IV. Provider business mailing address

1300 N 4TH ST
LONGVIEW TX
75601-4717
US

V. Phone/Fax

Practice location:
  • Phone: 903-234-7060
  • Fax: 903-753-2249
Mailing address:
  • Phone: 903-234-7060
  • Fax: 903-753-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number23409
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: