Provider Demographics
NPI:1578595088
Name:PEHANIC, ERIK (RPH)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:
Last Name:PEHANIC
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:ERIK
Other - Middle Name:
Other - Last Name:PEHANIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:704 166TH ST APT 6B
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2031
Mailing Address - Country:US
Mailing Address - Phone:917-568-5655
Mailing Address - Fax:
Practice Address - Street 1:8506A BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4104
Practice Address - Country:US
Practice Address - Phone:718-266-6160
Practice Address - Fax:718-266-6268
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY046941OtherLICENCE NUMBER