Provider Demographics
NPI:1225428881
Name:GANOE, ERICA
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:GANOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3722
Mailing Address - Country:US
Mailing Address - Phone:937-435-4096
Mailing Address - Fax:937-401-5211
Practice Address - Street 1:2300 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3722
Practice Address - Country:US
Practice Address - Phone:937-435-4096
Practice Address - Fax:937-401-5211
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH530107010143013183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician