Provider Demographics
NPI:1043810989
Name:BOTTOM, ERIKA SHEA
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:SHEA
Last Name:BOTTOM
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 1:759 QUIRKS RUN RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8976
Mailing Address - Country:US
Mailing Address - Phone:859-516-1448
Mailing Address - Fax:
Practice Address - Street 1:1000 BYPASS N
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-9462
Practice Address - Country:US
Practice Address - Phone:502-839-1482
Practice Address - Fax:502-839-4268
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist