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General NPI Number Information
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NPI Number | 1053471292
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Entity Type | Organization
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Legal Business Name | ERICKSON DRUG INC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 1583 HAMLINE AVE N
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City | SAINT PAUL
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State | MN
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Zip | 55108-2139
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Country | US
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Telephone | 651-646-9645
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Fax | 651-632-2164
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Provider Business Mailing Address
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Address Line | 1583 HAMLINE AVE N
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City | SAINT PAUL
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State | MN
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Zip | 55108-2139
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Country | US
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Telephone | 651-646-9645
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Fax | 651-632-2164
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Authorized Official
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Title or Position | OWNER AND SEC TREAS
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Name | ROBERT KOZIOL
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Credential | PHARM D
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Telephone | 952-469-2964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 262902
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License Number State | MN
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