Provider Demographics
NPI:1922379841
Name:WRIGHT, ERICA LAWAYN (DPH)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LAWAYN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-3737
Mailing Address - Country:US
Mailing Address - Phone:918-713-5400
Mailing Address - Fax:918-713-5492
Practice Address - Street 1:269 S 7TH ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-3737
Practice Address - Country:US
Practice Address - Phone:918-713-5400
Practice Address - Fax:918-713-5492
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8861183500000X
KS1-14089183500000X
MO044396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist