Provider Demographics
NPI:1912157561
Name:ATHEARN, ERIN P (PRH)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:P
Last Name:ATHEARN
Suffix:
Gender:F
Credentials:PRH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2508
Mailing Address - Country:US
Mailing Address - Phone:631-218-7982
Mailing Address - Fax:
Practice Address - Street 1:102 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2508
Practice Address - Country:US
Practice Address - Phone:631-218-7982
Practice Address - Fax:631-218-7988
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60404214183500000X
VA0202209607183500000X
NY49037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02666659Medicaid