Provider Demographics
NPI:1679722789
Name:EBEA, PATRICK O (RPH)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:O
Last Name:EBEA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 E FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-5441
Mailing Address - Country:US
Mailing Address - Phone:718-365-9354
Mailing Address - Fax:718-365-0211
Practice Address - Street 1:58 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-5441
Practice Address - Country:US
Practice Address - Phone:718-365-9354
Practice Address - Fax:718-365-0211
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist