Provider Demographics
NPI:1124330212
Name:DUBOIS, ERICA B (RPH)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:B
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BRIDLE LN
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-4462
Mailing Address - Country:US
Mailing Address - Phone:781-378-1103
Mailing Address - Fax:
Practice Address - Street 1:8 BRIDLE LN
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4462
Practice Address - Country:US
Practice Address - Phone:781-378-1103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23424183500000X
FLPS 31768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist