Provider Demographics
NPI:1710640867
Name:PUSEY, ERIC MICHAEL (RPH, CDE)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MICHAEL
Last Name:PUSEY
Suffix:
Gender:M
Credentials:RPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 BURKE BYP
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1805
Mailing Address - Country:US
Mailing Address - Phone:570-383-6700
Mailing Address - Fax:570-383-9700
Practice Address - Street 1:518 BURKE BYP
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1805
Practice Address - Country:US
Practice Address - Phone:570-383-6700
Practice Address - Fax:570-383-9700
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032474L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011414540001Medicaid