Provider Demographics
NPI:1316186901
Name:SHORT, ERIC VICTOR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:VICTOR
Last Name:SHORT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:AL
Mailing Address - Zip Code:35550-1414
Mailing Address - Country:US
Mailing Address - Phone:205-648-9918
Mailing Address - Fax:205-648-9644
Practice Address - Street 1:83 MAIN ST
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AL
Practice Address - Zip Code:35550-1414
Practice Address - Country:US
Practice Address - Phone:205-648-9918
Practice Address - Fax:205-648-9644
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13847183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL13847OtherPHARMACY LICENSE NUMBER