1386923795 NPI number — MRS. ERICA RACHELLE DURANT PHARMD, RPH

Table of content: MRS. ERICA RACHELLE DURANT PHARMD, RPH (NPI 1386923795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386923795 NPI number — MRS. ERICA RACHELLE DURANT PHARMD, RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURANT
Provider First Name:
ERICA
Provider Middle Name:
RACHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD, RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FISHER
Provider Other First Name:
ERICA
Provider Other Middle Name:
RACHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386923795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5942 S SALINA ST
Provider Second Line Business Mailing Address:
RA10755
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13205-3326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-469-3254
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5942 S SALINA ST
Provider Second Line Business Practice Location Address:
RA10755
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13205-3326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-469-3254
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2011

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:  055924 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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