Provider Demographics
NPI:1215533591
Name:FOX, ERIC VERN (RPH)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:VERN
Last Name:FOX
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 CARBON MINE RD
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-4205
Mailing Address - Country:US
Mailing Address - Phone:610-804-7028
Mailing Address - Fax:
Practice Address - Street 1:360 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:CURWENSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16833-1158
Practice Address - Country:US
Practice Address - Phone:814-236-1820
Practice Address - Fax:814-236-9096
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043882L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARPI013999OtherAUTHORIZATION TO ADMINISTER INJECTABLES
PARP043882LOtherPENNSYLVANIA PHARMACIST LICENSE