Provider Demographics
NPI:1699109439
Name:MAHONEY, ERIN (PHARMD)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:MAHONEY
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 1:1791 PARK AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-4307
Mailing Address - Country:US
Mailing Address - Phone:608-322-7739
Mailing Address - Fax:
Practice Address - Street 1:3301 CHURCH ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-5314
Practice Address - Country:US
Practice Address - Phone:715-345-2843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17152-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist