Provider Demographics
NPI:1619110137
Name:ASARERPH, ERIC B (RPH)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:B
Last Name:ASARERPH
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 1:124A SOUTH 13TH AVENUE
Mailing Address - Street 2:FLR# 2
Mailing Address - City:MT. VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550
Mailing Address - Country:US
Mailing Address - Phone:609-439-2639
Mailing Address - Fax:
Practice Address - Street 1:568 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3407
Practice Address - Country:US
Practice Address - Phone:212-865-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053137-1183500000X
NJ28RI02911700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY053137-1OtherPHARMACIST LIC #
NJ28RI02911700OtherPHARMACIST