MEDICARE: MRS. DAVA MERYL EISNER R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	044921	NY

General Provider Information

NPI Number	:	1356440036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAVA MERYL EISNER R.PH.

Provider Business Mailing Address
First Line	:	4279 WEBSTER AVE.
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10470-2120
Country	:	US
Telephone Number	:	718-652-2090
Fax Number	:	718-231-9580

Provider Business Practice Location Address
First Line	:	4279 WEBSTER AVE.
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10470-2120
Country	:	US
Telephone Number	:	718-652-2090
Fax Number	:	718-231-9580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	02/20/2015

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