Provider Demographics
NPI:1790181741
Name:DURST, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:DURST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 60 BOX 59A
Mailing Address - Street 2:
Mailing Address - City:LEVELS
Mailing Address - State:WV
Mailing Address - Zip Code:25431-9315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:191 MARKET ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-4750
Practice Address - Country:US
Practice Address - Phone:540-545-4961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207888183500000X
WVRP0007091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist