Provider Demographics
NPI:1790511046
Name:SHUGARTS, ERIC R (FD)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:R
Last Name:SHUGARTS
Suffix:
Gender:M
Credentials:FD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15824-1901
Mailing Address - Country:US
Mailing Address - Phone:814-268-2732
Mailing Address - Fax:
Practice Address - Street 1:1033 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROCKWAY
Practice Address - State:PA
Practice Address - Zip Code:15824-1901
Practice Address - Country:US
Practice Address - Phone:814-268-2732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFR00059L176P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176P00000XOther Service ProvidersFuneral Director