Provider Demographics
NPI:1265696207
Name:EROSCHENKO, KATHY S (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:S
Last Name:EROSCHENKO
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 1:2356 E MCPHERSON ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4798
Mailing Address - Country:US
Mailing Address - Phone:208-610-8207
Mailing Address - Fax:
Practice Address - Street 1:1109 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3626
Practice Address - Country:US
Practice Address - Phone:208-947-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist