Provider Demographics
NPI:1164411476
Name:ERRAMOUSPE, JOHN (PHARMD, MS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ERRAMOUSPE
Suffix:
Gender:M
Credentials:PHARMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 S 5TH AVE
Mailing Address - Street 2:COLLEGE OF PHARMACY PPRA, IDAHO STATE UNIVERSITY
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83209-0001
Mailing Address - Country:US
Mailing Address - Phone:208-282-3019
Mailing Address - Fax:
Practice Address - Street 1:970 S 5TH AVE
Practice Address - Street 2:COLLEGE OF PHARMACY PPRA, IDAHO STATE UNIVERSITY
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209-0001
Practice Address - Country:US
Practice Address - Phone:208-282-3019
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist