Provider Demographics
NPI:1003405531
Name:FOSNOCK, ERIC JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:FOSNOCK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 MERRIMACK ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5871
Mailing Address - Country:US
Mailing Address - Phone:978-327-6551
Mailing Address - Fax:978-327-6554
Practice Address - Street 1:380 MERRIMACK ST STE 1B
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5871
Practice Address - Country:US
Practice Address - Phone:978-327-6551
Practice Address - Fax:978-327-6554
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH235209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist