Healthcare Provider Details

I. General information

NPI: 1568060911
Provider Name (Legal Business Name): ERICA J PARENTE CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA J SEVERSON-PARENTE CPHT

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 STATE ST
AUGUSTA KS
67010-1107
US

IV. Provider business mailing address

1001 CUSTER LN
AUGUSTA KS
67010-9511
US

V. Phone/Fax

Practice location:
  • Phone: 316-775-2289
  • Fax: 316-775-2280
Mailing address:
  • Phone: 316-680-5130
  • Fax: 316-775-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number14-10655
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: