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General NPI Number Information
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NPI Number | 1407382781
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Entity Type | Individual
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Provider Name | ERICK DEETON SR.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 8400 BRADSHAW RD
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City | ELK GROVE
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State | CA
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Zip | 95624-1420
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Country | US
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Telephone | 916-689-1124
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Fax | 916-689-1157
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Provider Business Mailing Address
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Address Line | 10010 SEATTLE SLEW LN
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City | ELK GROVE
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State | CA
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Zip | 95624-5037
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Country | US
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Telephone | 916-627-5689
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 63051
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License Number State | CA
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