Provider Demographics
NPI:1235489873
Name:LACHANCE, ERICA JANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:JANE
Last Name:LACHANCE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CHRISTOPHER CT
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8321
Mailing Address - Country:US
Mailing Address - Phone:904-616-6744
Mailing Address - Fax:
Practice Address - Street 1:1440 US HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4211
Practice Address - Country:US
Practice Address - Phone:904-824-7127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist