Provider Demographics
NPI:1013019736
Name:JEFFERSON, ERICA LEANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LEANNE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:LEANNE
Other - Last Name:ZEIGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5205 GOLDEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-3980
Mailing Address - Country:US
Mailing Address - Phone:254-220-7755
Mailing Address - Fax:
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:CRDAMC DEPARTMENT OF PHARMACY
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-8828
Practice Address - Fax:254-288-8961
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist