Provider Demographics
NPI:1235106071
Name:ERDMAN, KIRK B (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:B
Last Name:ERDMAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 415
Mailing Address - Street 2:
Mailing Address - City:PAXINOS
Mailing Address - State:PA
Mailing Address - Zip Code:17860-9643
Mailing Address - Country:US
Mailing Address - Phone:570-648-3878
Mailing Address - Fax:
Practice Address - Street 1:400 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-5716
Practice Address - Country:US
Practice Address - Phone:570-648-7891
Practice Address - Fax:570-648-2007
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045586R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist