Provider Demographics
NPI:1154013530
Name:NOVIANA, ERIN (RPH (PHARMACIST))
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:NOVIANA
Suffix:
Gender:F
Credentials:RPH (PHARMACIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 JEREMY CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1856
Mailing Address - Country:US
Mailing Address - Phone:707-812-3992
Mailing Address - Fax:
Practice Address - Street 1:3301 JEREMY CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-1856
Practice Address - Country:US
Practice Address - Phone:707-812-3992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH66556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist