Provider Demographics
NPI:1811641475
Name:CIRILLO, ERIN VICTORIA
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:VICTORIA
Last Name:CIRILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BROWNSBURG RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-9663
Mailing Address - Country:US
Mailing Address - Phone:609-841-1721
Mailing Address - Fax:
Practice Address - Street 1:2923 E THOMPSON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4812
Practice Address - Country:US
Practice Address - Phone:215-739-0548
Practice Address - Fax:215-739-1579
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040642L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015440460001Medicaid