Provider Demographics
NPI:1144506304
Name:BAXTER, ERICKA C (PHARM D)
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:C
Last Name:BAXTER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2563 PAYDON RANDOFF RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45434-4238
Mailing Address - Country:US
Mailing Address - Phone:937-429-3251
Mailing Address - Fax:937-429-3251
Practice Address - Street 1:5000 BRANDT PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-6108
Practice Address - Country:US
Practice Address - Phone:937-236-0495
Practice Address - Fax:937-236-1398
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03124330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist