Provider Demographics
NPI:1073142378
Name:DORMAN, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:DORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:DORMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPHT
Mailing Address - Street 1:105 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:PENN
Mailing Address - State:PA
Mailing Address - Zip Code:15675-9508
Mailing Address - Country:US
Mailing Address - Phone:724-875-8440
Mailing Address - Fax:
Practice Address - Street 1:8931 ROUTE 30
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2704
Practice Address - Country:US
Practice Address - Phone:724-863-5398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA350101060350931183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician