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NPI Code Detail

MEDICARE: WAYNE ERICHSEN

MEDICARE: WAYNE ERICHSEN
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
1183500000XPharmacist6725AZ

General Provider Information

NPI Number : 1811309263
Entity Type Code : Individual
Provider Name (Legal Business Name) : WAYNE ERICHSEN
Provider Business Mailing Address
First Line : 5635 S ROCKY POINT RD
Second Line :
City : TEMPE
State : AZ
Zip : 85283-2133
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1212 S GREENFIELD RD
Second Line :
City : MESA
State : AZ
Zip : 85206-2792
Country : US
Telephone Number : 480-654-8920
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2014
Last Update Date : 05/20/2014

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Directions to “ WAYNE ERICHSEN ” Practice Location

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