Provider Demographics
NPI:1053989566
Name:DENNIS, ERICA (CPHT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N LEROY ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-5308
Mailing Address - Country:US
Mailing Address - Phone:810-750-1923
Mailing Address - Fax:810-714-4128
Practice Address - Street 1:1001 N LEROY ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-5308
Practice Address - Country:US
Practice Address - Phone:810-750-1923
Practice Address - Fax:810-714-4128
Is Sole Proprietor?:No
Enumeration Date:2021-06-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303010684183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5303010684OtherPHARMACY TECHNICIAN LICENSE