Provider Demographics
NPI:1144974650
Name:NAGEL, ERIC JOHN (PHARMD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:NAGEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 TANAGER DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-9645
Mailing Address - Country:US
Mailing Address - Phone:734-735-2069
Mailing Address - Fax:
Practice Address - Street 1:1704 S CUSTER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1622
Practice Address - Country:US
Practice Address - Phone:734-243-5451
Practice Address - Fax:734-243-4354
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist