Provider Demographics
NPI:1922386937
Name:STEVENSON, ERICA CIPRIANO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:CIPRIANO
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5396 STATE HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-3716
Mailing Address - Country:US
Mailing Address - Phone:607-334-6029
Mailing Address - Fax:
Practice Address - Street 1:311 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:GLENMONT
Practice Address - State:NY
Practice Address - Zip Code:12077
Practice Address - Country:US
Practice Address - Phone:518-432-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
055727OtherSTATE LICENSE NUMBER
NY55727OtherNEW YORK STATE