Provider Demographics
NPI:1306141395
Name:DEEUGENIO, DEBORAH (PHARMD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DEEUGENIO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:MAYRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3307 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5101
Mailing Address - Country:US
Mailing Address - Phone:215-707-4916
Mailing Address - Fax:215-707-8362
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-3416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045935L1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist