Provider Demographics
NPI:1528296290
Name:GRAY, ERIKA ILDIKO (INTERN PHARMACIST)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:ILDIKO
Last Name:GRAY
Suffix:
Gender:F
Credentials:INTERN PHARMACIST
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:ILDIKO
Other - Last Name:KOLTAVARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 NINOS
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:714-838-3942
Practice Address - Street 1:3 NINOS
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620
Practice Address - Country:US
Practice Address - Phone:714-731-1981
Practice Address - Fax:714-838-3942
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201161835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric