MEDICARE: DR. ERIN P JERICO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP0008186	WV

General Provider Information

NPI Number	:	1508290925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN P JERICO PHARMD

Provider Business Mailing Address
First Line	:	520 N STATE ROUTE 2
Second Line	:
City	:	NEW MARTINSVILLE
State	:	WV
Zip	:	26155-2700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 N STATE ROUTE 2
Second Line	:
City	:	NEW MARTINSVILLE
State	:	WV
Zip	:	26155-2700
Country	:	US
Telephone Number	:	304-455-1790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/22/2013

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