Provider Demographics
NPI:1821817388
Name:CLIFTON, ERIN HALEY
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:HALEY
Last Name:CLIFTON
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 1:137 CALUMET ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ROXBURY CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:02120-3486
Mailing Address - Country:US
Mailing Address - Phone:407-937-8457
Mailing Address - Fax:
Practice Address - Street 1:429 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5410
Practice Address - Country:US
Practice Address - Phone:617-232-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPI1000796333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy