Provider Demographics
NPI:1821489162
Name:RIOUX, ERIKA (621007010358480)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:RIOUX
Suffix:
Gender:F
Credentials:621007010358480
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 DONALD LYNCH BLVD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-4709
Mailing Address - Country:US
Mailing Address - Phone:508-573-1005
Mailing Address - Fax:508-970-8404
Practice Address - Street 1:9 SIMON DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1015
Practice Address - Country:US
Practice Address - Phone:413-250-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT15981183700000X
620107010358480183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
620107010358480OtherPTCB LICENSE
MAPT15981OtherMA STATE REGISTRATION