Provider Demographics
NPI:1013194125
Name:SCHLADEBECK, ERIC M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:SCHLADEBECK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 NICHOLS ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-2180
Mailing Address - Country:US
Mailing Address - Phone:585-349-3562
Mailing Address - Fax:585-349-3564
Practice Address - Street 1:42 NICHOLS ST
Practice Address - Street 2:SUITE 11
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-2180
Practice Address - Country:US
Practice Address - Phone:585-349-3562
Practice Address - Fax:585-349-3564
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0516171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02917917Medicaid