Provider Demographics
NPI:1578749503
Name:BOOTH, ERIC THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:THOMAS
Last Name:BOOTH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14839
Mailing Address - Country:US
Mailing Address - Phone:607-225-4633
Mailing Address - Fax:607-324-7363
Practice Address - Street 1:1000 STATE ROUTE 36
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843
Practice Address - Country:US
Practice Address - Phone:607-324-7225
Practice Address - Fax:607-324-7363
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist