Provider Demographics
NPI:1609989086
Name:SOUTHWORTH, ERIN L (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:L
Last Name:SOUTHWORTH
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 1:302 HAMPSTEAD CT
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4231
Mailing Address - Country:US
Mailing Address - Phone:317-776-1423
Mailing Address - Fax:
Practice Address - Street 1:2620 KESSLER BOULEVARD EAST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2890
Practice Address - Country:US
Practice Address - Phone:317-475-6007
Practice Address - Fax:317-475-6076
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021067A183500000X
IL51289110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist