Healthcare Provider Details

I. General information

NPI: 1811955743
Provider Name (Legal Business Name): ERIE VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 01/04/2023
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 EAST 38TH ST
ERIE PA
16504-1559
US

IV. Provider business mailing address

PO BOX 94439
CLEVELAND OH
44101-4439
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-8661
  • Fax: 814-860-2251
Mailing address:
  • Phone: 717-277-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIN DENISE POTTER
Title or Position: NPI TEAM
Credential:
Phone: 202-382-2579