Provider Demographics
NPI:1326659996
Name:LAGMAN, ERIN GRACE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERIN GRACE
Middle Name:
Last Name:LAGMAN
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 1:2327 PIZARRO LN APT 3101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7563
Mailing Address - Country:US
Mailing Address - Phone:702-308-8708
Mailing Address - Fax:
Practice Address - Street 1:8500 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6600
Practice Address - Country:US
Practice Address - Phone:321-242-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist