# ERICKSONS DIVERSIFIED LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** FAMILY FRESH MARKET PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114075488
- **Authorized official:** AMY ELLIS RPH (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (616) 878-2848

## Contact information

- **Practice address:** 110 W 4TH ST, NEW RICHMOND, WI 54017-1722
- **Practice address phone:** (715) 246-2186
- **Practice address fax:** (715) 246-7115
- **Mailing address:** 1527 MOMENTUM PL, CHICAGO, IL 60689-5315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 5254 | WI | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 01/05/2007
- **Last updated:** 10/31/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33129900 | — | WI |
| 01 | — | 5113054 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |