Provider Demographics
NPI:1881911121
Name:CHILDS, ERIC SCOTT (RPH)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:SCOTT
Last Name:CHILDS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 E HWY 190
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2254
Mailing Address - Country:US
Mailing Address - Phone:254-547-9755
Mailing Address - Fax:254-547-9858
Practice Address - Street 1:804 E HWY 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2254
Practice Address - Country:US
Practice Address - Phone:254-547-9755
Practice Address - Fax:254-547-9858
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist