Provider Demographics
NPI:1861076101
Name:KRAIZA, ERIN LUCY
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LUCY
Last Name:KRAIZA
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 1:400 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2121
Mailing Address - Country:US
Mailing Address - Phone:607-432-3200
Mailing Address - Fax:607-433-0401
Practice Address - Street 1:400 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2121
Practice Address - Country:US
Practice Address - Phone:607-432-3200
Practice Address - Fax:607-433-0401
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY450101080958679183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician