Provider Demographics
NPI:1033484068
Name:COURTER, ERIK ERNEST
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:ERNEST
Last Name:COURTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 PLACENTIA AVE SPC F6
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2825
Mailing Address - Country:US
Mailing Address - Phone:714-356-9274
Mailing Address - Fax:
Practice Address - Street 1:4000 BIRCH ST STE 120
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2258
Practice Address - Country:US
Practice Address - Phone:949-642-8057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29726183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29726OtherPHARMACY TECHNICIAN