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NPI Code Detail

MEDICARE: MR. JAMES E ERVIN RPH

MEDICARE:  MR. JAMES E ERVIN  RPH
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
1183500000XPharmacist044863KY
2183500000XPharmacist013490MO
3183500000XPharmacist26025414AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
126025414AOTHERININDIANA BOARD OF PHARMACY
2044863OTHERMOMISSOURI BOARD OF PHARMACY
3013490OTHERKYKENTUCKY BOARD OF PHARMACY

General Provider Information

NPI Number : 1629590047
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES E ERVIN RPH
Provider Business Mailing Address
First Line : 225 PIN OAK LN
Second Line :
City : MADISONVILLE
State : KY
Zip : 42431-8745
Country : US
Telephone Number : 615-480-6575
Fax Number :
Provider Business Practice Location Address
First Line : 1310 W MORTON ST
Second Line :
City : OAKLAND CITY
State : IN
Zip : 47660-7615
Country : US
Telephone Number : 812-749-4129
Fax Number : 812-749-4561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2017
Last Update Date : 07/07/2017

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Directions to “ MR. JAMES E ERVIN RPH” Practice Location

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