Healthcare Provider Details

I. General information

NPI: 1033468640
Provider Name (Legal Business Name): ERICA SYKES PHARMACIST INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8375 W DEER VALLEY RD
PEORIA AZ
85382
US

IV. Provider business mailing address

6234 W BEHREND DR #2106
GLENDALE AZ
85308
US

V. Phone/Fax

Practice location:
  • Phone: 623-561-5196
  • Fax:
Mailing address:
  • Phone: 602-748-8657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI009596
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: