Provider Demographics
NPI:1689326332
Name:BORAL, ERIN KAYE (PHARMD)
Entity type:Individual
Prefix:
First Name:ERIN KAYE
Middle Name:
Last Name:BORAL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832B FROELICH AVE
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE MDL
Mailing Address - State:NJ
Mailing Address - Zip Code:08640-1818
Mailing Address - Country:US
Mailing Address - Phone:702-501-3235
Mailing Address - Fax:
Practice Address - Street 1:3458 NEELY RD
Practice Address - Street 2:
Practice Address - City:JOINT BASE MDL
Practice Address - State:NJ
Practice Address - Zip Code:08641-5312
Practice Address - Country:US
Practice Address - Phone:609-754-9464
Practice Address - Fax:609-754-9133
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04202300183500000X
COPHA.0023727183500000X
NV20186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist