Provider Demographics
NPI:1548863723
Name:EBERHARDT, ERICA E
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:E
Last Name:EBERHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 HERITAGE LN APT B3
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-1630
Mailing Address - Country:US
Mailing Address - Phone:315-730-7157
Mailing Address - Fax:
Practice Address - Street 1:137 WEST BOYLSTON STREET
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583
Practice Address - Country:US
Practice Address - Phone:508-835-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist