MEDICARE: ERICA DAWN WHEELER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	119042	MN

General Provider Information

NPI Number	:	1669369443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA DAWN WHEELER

Provider Business Mailing Address
First Line	:	6830 150TH AVE NW
Second Line	:
City	:	RAMSEY
State	:	MN
Zip	:	55303-4200
Country	:	US
Telephone Number	:	612-235-0346
Fax Number	:

Provider Business Practice Location Address
First Line	:	19216 FREEPORT ST NW
Second Line	:
City	:	ELK RIVER
State	:	MN
Zip	:	55330-1265
Country	:	US
Telephone Number	:	763-241-8112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	06/23/2025

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