Provider Demographics
NPI:1679210033
Name:UNDERWOOD, ERIC LOUIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LOUIS
Last Name:UNDERWOOD
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 1:10 S MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:IN
Mailing Address - Zip Code:47353-1341
Mailing Address - Country:US
Mailing Address - Phone:765-223-2121
Mailing Address - Fax:765-223-2029
Practice Address - Street 1:10 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:IN
Practice Address - Zip Code:47353-1341
Practice Address - Country:US
Practice Address - Phone:765-223-2121
Practice Address - Fax:765-223-2029
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029488A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist