Provider Demographics
NPI:1821340043
Name:MABUS, ERIK MASON (RPH)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:MASON
Last Name:MABUS
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 1:276 LINDLEY DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3806
Mailing Address - Country:US
Mailing Address - Phone:302-632-5149
Mailing Address - Fax:302-735-7556
Practice Address - Street 1:200 W LOOCKERMAN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3248
Practice Address - Country:US
Practice Address - Phone:302-632-5149
Practice Address - Fax:302-735-7556
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist