Provider Demographics
NPI:1962889642
Name:DALY, EUGENE
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:DALY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 EAST RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2806
Mailing Address - Country:US
Mailing Address - Phone:908-241-6337
Mailing Address - Fax:908-634-4038
Practice Address - Street 1:575 UNDERHILL BLVD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-0000
Practice Address - Country:US
Practice Address - Phone:908-241-6337
Practice Address - Fax:908-634-4038
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ036877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist