Provider Demographics
NPI:1285238725
Name:DECAMINADA, EUGENE B (BSPHARM, RPH)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:B
Last Name:DECAMINADA
Suffix:
Gender:M
Credentials:BSPHARM, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CRAIGMOOR RD S
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-1711
Mailing Address - Country:US
Mailing Address - Phone:203-395-6378
Mailing Address - Fax:
Practice Address - Street 1:600 DERBY AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1000
Practice Address - Country:US
Practice Address - Phone:203-395-6378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist