Provider Demographics
NPI:1134640469
Name:FINK, ERIC THOMAS
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:THOMAS
Last Name:FINK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 W HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9307
Mailing Address - Country:US
Mailing Address - Phone:517-525-4459
Mailing Address - Fax:
Practice Address - Street 1:1355 W HOWELL RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-9307
Practice Address - Country:US
Practice Address - Phone:517-525-4459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042866390200000X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program