Healthcare Provider Details

I. General information

NPI: 1134322845
Provider Name (Legal Business Name): MR. ERICK A MAXWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHGATE PKWY
WHEELING IL
60090-3201
US

IV. Provider business mailing address

1324 HANCOCK ST
BELLEVUE NE
68005-2710
US

V. Phone/Fax

Practice location:
  • Phone: 402-592-5244
  • Fax: 402-592-2501
Mailing address:
  • Phone: 402-614-9758
  • Fax: 402-592-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: