Provider Demographics
NPI:1124508361
Name:VERDUSCO, ERICA LISSETTE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LISSETTE
Last Name:VERDUSCO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 RIVERSIDE DR UNIT C135
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3395
Mailing Address - Country:US
Mailing Address - Phone:509-901-0898
Mailing Address - Fax:
Practice Address - Street 1:501 N MILLER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2041
Practice Address - Country:US
Practice Address - Phone:509-663-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60837616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist