Provider Demographics
NPI:1205857786
Name:ERVIN, ANN (RPH MHA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:ERVIN
Suffix:
Gender:F
Credentials:RPH MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 LAKE VIEW TER
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1033
Mailing Address - Country:US
Mailing Address - Phone:609-658-8255
Mailing Address - Fax:609-259-6735
Practice Address - Street 1:1280 YARDVILLE ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08501-1818
Practice Address - Country:US
Practice Address - Phone:609-259-2202
Practice Address - Fax:609-259-6735
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01934700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist