Provider Demographics
NPI:1043497563
Name:PACCHIONI, EDUARDO JOSE (R,PH)
Entity type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:JOSE
Last Name:PACCHIONI
Suffix:
Gender:M
Credentials:R,PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-0251
Mailing Address - Country:US
Mailing Address - Phone:516-236-2561
Mailing Address - Fax:
Practice Address - Street 1:503 LARCH LN
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-3728
Practice Address - Country:US
Practice Address - Phone:516-236-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2010-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34869183500000X
CA38799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist