Individual
CHARLES PAUL ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
1504 190TH AVE, SUITE 100, BALSAM LAKE, WI 54810-7102
(715) 825-4498
(715) 825-4499
Mailing address
204 S ADAMS ST, SAINT CROIX FALLS, WI 54024-9449
(715) 483-0260
(715) 483-0516
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
112562
MN
183500000X
Pharmacist
Primary
155110-40
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112562
PHARMACIST LICENSE
MN
01
—
155110-40
PHARMACIST LICENSE
WI
Enumeration date
04/27/2012
Last updated
04/27/2012
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