Provider Demographics
NPI:1205125499
Name:LEVAN, ERIC MICHAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MICHAEL
Last Name:LEVAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 LITITZ PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4340
Mailing Address - Country:US
Mailing Address - Phone:717-290-2012
Mailing Address - Fax:
Practice Address - Street 1:40 AUTUMN FERN TRL
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-9998
Practice Address - Country:US
Practice Address - Phone:910-814-4062
Practice Address - Fax:910-814-4061
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21502183500000X
PARP446068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0435602Medicaid