Provider Demographics
NPI:1245526045
Name:ERWIN, TINA MICHELLE (BS)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MICHELLE
Last Name:ERWIN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MICHELLE
Other - Last Name:VOEGELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:501 ELSINGER BLVD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4717
Mailing Address - Country:US
Mailing Address - Phone:501-328-5316
Mailing Address - Fax:501-328-5316
Practice Address - Street 1:501 ELSINGER BLVD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4717
Practice Address - Country:US
Practice Address - Phone:501-328-5316
Practice Address - Fax:501-328-5316
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist