Provider Demographics
NPI:1639416670
Name:KILLEN, ERICA CARMEN (RPH)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:CARMEN
Last Name:KILLEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:CARMEN
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:326 GAINESBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-8980
Mailing Address - Country:US
Mailing Address - Phone:404-933-3988
Mailing Address - Fax:
Practice Address - Street 1:7953 VILLA RICA HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-8619
Practice Address - Country:US
Practice Address - Phone:678-840-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist