Provider Demographics
NPI:1760798342
Name:WITTS, ERNEST RAYMOND JR (RPH)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:RAYMOND
Last Name:WITTS
Suffix:JR
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 1:935 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1055
Mailing Address - Country:US
Mailing Address - Phone:978-851-6331
Mailing Address - Fax:978-858-3910
Practice Address - Street 1:935 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1055
Practice Address - Country:US
Practice Address - Phone:978-851-6331
Practice Address - Fax:978-858-3910
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist