Provider Demographics
NPI:1992323752
Name:ENGEN, EILEEN FERN (PHARMD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:FERN
Last Name:ENGEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:FERN
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5003 HAWTHORNE DR APT I
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-6910
Mailing Address - Country:US
Mailing Address - Phone:715-817-1144
Mailing Address - Fax:
Practice Address - Street 1:3501 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1012
Practice Address - Country:US
Practice Address - Phone:515-967-1794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist