Provider Demographics
NPI:1629590047
Name:ERVIN, JAMES E (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:ERVIN
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 1:225 PIN OAK LN
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-8745
Mailing Address - Country:US
Mailing Address - Phone:615-480-6575
Mailing Address - Fax:
Practice Address - Street 1:1310 W MORTON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND CITY
Practice Address - State:IN
Practice Address - Zip Code:47660-7615
Practice Address - Country:US
Practice Address - Phone:812-749-4129
Practice Address - Fax:812-749-4561
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY044863183500000X
MO013490183500000X
IN26025414A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26025414AOtherINDIANA BOARD OF PHARMACY
MO044863OtherMISSOURI BOARD OF PHARMACY
KY013490OtherKENTUCKY BOARD OF PHARMACY