Provider Demographics
NPI:1689050775
Name:VODKA, ERIN MICHELLE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELLE
Last Name:VODKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MICHELLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2150 FAIRGROUNDS RD NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0641
Mailing Address - Country:US
Mailing Address - Phone:503-428-5107
Mailing Address - Fax:
Practice Address - Street 1:2150 FAIRGROUNDS RD NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0641
Practice Address - Country:US
Practice Address - Phone:503-428-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0014795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist