Provider Demographics
NPI:1033714464
Name:GAY, ERIC W (RPH)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:W
Last Name:GAY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 STATE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-1958
Mailing Address - Country:US
Mailing Address - Phone:618-943-7571
Mailing Address - Fax:618-943-2323
Practice Address - Street 1:1421 STATE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-1958
Practice Address - Country:US
Practice Address - Phone:618-943-7571
Practice Address - Fax:618-943-2323
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist