Provider Demographics
NPI:1295016137
Name:FONBAH, ERIN HUMBLES (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:HUMBLES
Last Name:FONBAH
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 1:2012 RIVER BIRCH WAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6754
Mailing Address - Country:US
Mailing Address - Phone:205-983-3734
Mailing Address - Fax:205-408-6894
Practice Address - Street 1:100 W FORT WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2430
Practice Address - Country:US
Practice Address - Phone:256-249-8646
Practice Address - Fax:256-249-9319
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16019183500000X
TX44561183500000X
LA18703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist