Basic Information
| Provider Information | |||||||||
| NPI: | 1043339567 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUSE | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | MCMAHON | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 WYNDHAM PL | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277056440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193822910 | ||||||||
| FaxNumber: | 3365703752 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 N GRAHAM HOPEDALE RD | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272172971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365320414 | ||||||||
| FaxNumber: | 3365703752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 12884 | NC | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 12884 | 01 | NC | NC BOP LICENSE NUMBER | OTHER |