1649415514 NPI number — JEFFREY DAVID ERMAN PHARMD

Table of content: JEFFREY DAVID ERMAN PHARMD (NPI 1649415514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649415514 NPI number — JEFFREY DAVID ERMAN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERMAN
Provider First Name:
JEFFREY
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649415514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3909 BEECHER RD
Provider Second Line Business Mailing Address:
PHARMACY DEPARTMENT
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-3602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-762-1145
Provider Business Mailing Address Fax Number:
810-762-4260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3909 BEECHER RD
Provider Second Line Business Practice Location Address:
PHARMACY DEPARTMENT
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-762-1145
Provider Business Practice Location Address Fax Number:
810-762-4260
Provider Enumeration Date:
12/08/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  5302035731 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)