Provider Demographics
NPI:1689967416
Name:ERXLEBEN, JEREMY AARON (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:AARON
Last Name:ERXLEBEN
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 1:1130 AVE ASHFORD
Mailing Address - Street 2:
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1230
Mailing Address - Country:US
Mailing Address - Phone:787-721-7895
Mailing Address - Fax:
Practice Address - Street 1:1130 AVE ASHFORD
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907-1230
Practice Address - Country:US
Practice Address - Phone:787-721-7895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PW5468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist