Provider Demographics
NPI:1669753158
Name:DERKS, ERIN E (PHARMD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:DERKS
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 1:5932 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2137
Mailing Address - Country:US
Mailing Address - Phone:708-652-4856
Mailing Address - Fax:708-652-2109
Practice Address - Street 1:5932 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2137
Practice Address - Country:US
Practice Address - Phone:708-652-4856
Practice Address - Fax:708-652-2109
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.289528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist