Provider Demographics
NPI:1093082273
Name:ERVIN, REBEKAH CYNTHIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:CYNTHIA
Last Name:ERVIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 HANOVER CT
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4004
Mailing Address - Country:US
Mailing Address - Phone:916-769-1488
Mailing Address - Fax:
Practice Address - Street 1:1919 FULTON AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1905
Practice Address - Country:US
Practice Address - Phone:916-483-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist