Provider Demographics
NPI:1417552050
Name:ERZAH, ERIC ETIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ETIE
Last Name:ERZAH
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 1:20838 BLANCO RD APT 7301
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-1514
Mailing Address - Country:US
Mailing Address - Phone:512-647-0522
Mailing Address - Fax:
Practice Address - Street 1:22202 BULVERDE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261-3080
Practice Address - Country:US
Practice Address - Phone:210-497-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist