Provider Demographics
NPI:1073943940
Name:SVOBODA, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:SVOBODA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084-0012
Mailing Address - Country:US
Mailing Address - Phone:573-378-5421
Mailing Address - Fax:573-378-6554
Practice Address - Street 1:1003 W NEWTON ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1813
Practice Address - Country:US
Practice Address - Phone:573-378-5421
Practice Address - Fax:573-378-6554
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012017837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist