Provider Demographics
NPI:1164717641
Name:ERSKINE, MICHAEL JOHN
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:ERSKINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MARQUIS PKWY
Mailing Address - Street 2:TARGET T2296
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5371
Mailing Address - Country:US
Mailing Address - Phone:757-259-3021
Mailing Address - Fax:757-259-3013
Practice Address - Street 1:200 MARQUIS PKWY
Practice Address - Street 2:TARGET T2296
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5371
Practice Address - Country:US
Practice Address - Phone:757-259-3021
Practice Address - Fax:757-259-3013
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist