Provider Demographics
NPI:1043490386
Name:SMITH, ERIC J (RPH)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:SMITH
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 1:214 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:14136-1339
Mailing Address - Country:US
Mailing Address - Phone:716-934-3980
Mailing Address - Fax:716-934-0174
Practice Address - Street 1:214 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SILVER CREEK
Practice Address - State:NY
Practice Address - Zip Code:14136-1339
Practice Address - Country:US
Practice Address - Phone:716-934-3980
Practice Address - Fax:716-934-0174
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0383871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1013026335Medicaid