Provider Demographics
NPI:1881054385
Name:ERLANDSEN, ESPEN
Entity type:Individual
Prefix:
First Name:ESPEN
Middle Name:
Last Name:ERLANDSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4640
Mailing Address - Country:US
Mailing Address - Phone:916-663-5898
Mailing Address - Fax:
Practice Address - Street 1:3300 BLACK OAK DR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4640
Practice Address - Country:US
Practice Address - Phone:916-663-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist