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Organization
ERICKSONS DIVERSIFIED LLC
Active
Organization
ERICKSONS DIVERSIFIED LLC
Active
Other names
FAMILY FRESH MARKET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AMY ELLIS RPH (DIRECTOR OF PHARMACY)
(616) 878-2848
Entity
Organization
Contact information
Practice address
110 W 4TH ST, NEW RICHMOND, WI 54017-1722
(715) 246-2186
(715) 246-7115
Mailing address
1527 MOMENTUM PL, CHICAGO, IL 60689-5315
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
5254
WI
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33129900
—
WI
01
—
5113054
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
01/05/2007
Last updated
10/31/2025
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