Provider Demographics
NPI:1639831852
Name:EICHENLAUB, ERIC ROBERT
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ROBERT
Last Name:EICHENLAUB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 N MAIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1542
Mailing Address - Country:US
Mailing Address - Phone:724-282-9160
Mailing Address - Fax:
Practice Address - Street 1:1521 N MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1542
Practice Address - Country:US
Practice Address - Phone:724-282-9160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040011L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist