Provider Demographics
NPI:1417282815
Name:MONTIJO, ERIC DAVID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DAVID
Last Name:MONTIJO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 SPRINBGROOK AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5308
Mailing Address - Country:US
Mailing Address - Phone:919-553-6224
Mailing Address - Fax:919-553-7805
Practice Address - Street 1:95 SPRINBGROOK AVE
Practice Address - Street 2:STE 101
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5308
Practice Address - Country:US
Practice Address - Phone:919-553-6224
Practice Address - Fax:919-553-7805
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1417282815OtherBLUE CROSS BLUE SHIELD OF NORTH CAROLINA