Provider Demographics
NPI:1508281155
Name:WASS, ERIKA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:WASS
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 1:25590 PROSPECT AVE
Mailing Address - Street 2:APT 25G
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3141
Mailing Address - Country:US
Mailing Address - Phone:443-567-3779
Mailing Address - Fax:
Practice Address - Street 1:25590 PROSPECT AVE
Practice Address - Street 2:APT 25G
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3141
Practice Address - Country:US
Practice Address - Phone:443-567-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP447977183500000X
CA71738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist