Provider Demographics
NPI:1518211655
Name:OVERBY, ERIK N (BS PHARM)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:N
Last Name:OVERBY
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54534-1254
Mailing Address - Country:US
Mailing Address - Phone:715-561-5666
Mailing Address - Fax:715-561-5654
Practice Address - Street 1:314 SILVER ST
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:WI
Practice Address - Zip Code:54534-1254
Practice Address - Country:US
Practice Address - Phone:715-561-5666
Practice Address - Fax:715-561-5654
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-27
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1208440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist