Provider Demographics
NPI:1619261724
Name:DAUME, ERIC (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:DAUME
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63780-1329
Mailing Address - Country:US
Mailing Address - Phone:573-264-2450
Mailing Address - Fax:573-264-4741
Practice Address - Street 1:202 SIEMERS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-8419
Practice Address - Country:US
Practice Address - Phone:573-334-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008012997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist