Healthcare Provider Details

I. General information

NPI: 1013718089
Provider Name (Legal Business Name): THERESIA ERET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 PEACH ST
ERIE PA
16509-2602
US

IV. Provider business mailing address

3806 CALICO DR
ERIE PA
16506-4441
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-4624
  • Fax:
Mailing address:
  • Phone: 310-894-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP459176
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: