Provider Demographics
NPI:1467906107
Name:MCGURTY, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MCGURTY
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 1:2739 S CLEMENT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2262
Mailing Address - Country:US
Mailing Address - Phone:414-839-7660
Mailing Address - Fax:
Practice Address - Street 1:2739 S CLEMENT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-2262
Practice Address - Country:US
Practice Address - Phone:414-839-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18561-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist