Provider Demographics
NPI:1326793647
Name:ERWIN, JESSICA FAITH
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FAITH
Last Name:ERWIN
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 1:85 ORVIS RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:VT
Mailing Address - Zip Code:05443-9613
Mailing Address - Country:US
Mailing Address - Phone:802-498-5412
Mailing Address - Fax:
Practice Address - Street 1:85 ORVIS RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:VT
Practice Address - Zip Code:05443-9613
Practice Address - Country:US
Practice Address - Phone:802-498-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0003012183500000X
VT330003012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist