Provider Demographics
NPI:1538722731
Name:JOSTES, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:JOSTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 SWEDE GULCH RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-3713
Mailing Address - Country:US
Mailing Address - Phone:303-526-2334
Mailing Address - Fax:
Practice Address - Street 1:952 SWEDE GULCH RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-3713
Practice Address - Country:US
Practice Address - Phone:303-526-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist