Provider Demographics
NPI:1144829789
Name:STYSKAL, ERIC WILLIAM (RPH)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:WILLIAM
Last Name:STYSKAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8013 CORTE DEL LAGO
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-4576
Mailing Address - Country:US
Mailing Address - Phone:210-264-7127
Mailing Address - Fax:
Practice Address - Street 1:75 LAKE HAVASU AVE N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5651
Practice Address - Country:US
Practice Address - Phone:928-854-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist