Provider Demographics
NPI:1871779298
Name:PETER, EDO-ABASI JOHN (BS)
Entity type:Individual
Prefix:MS
First Name:EDO-ABASI
Middle Name:JOHN
Last Name:PETER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 OLMSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473
Mailing Address - Country:US
Mailing Address - Phone:718-823-4028
Mailing Address - Fax:718-823-4028
Practice Address - Street 1:920 OLMSTEAD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2013
Practice Address - Country:US
Practice Address - Phone:718-823-4028
Practice Address - Fax:718-823-4028
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041859-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist