Organization
ERICKSON DRUG INC
Active
Other names
ERICKSON DRUG INC
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT KOZIOL PHARMD (OWNER AND SECRETARY TREASURER)
(952) 469-2964
Entity
Organization
Contact information
Practice address
20751 HOLYOKE AVE, LAKEVILLE, MN 55044-9825
(952) 469-2964
(952) 469-6753
Mailing address
PO BOX 808, LAKEVILLE, MN 55044-0808
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2004130
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2044557
PK
—
05
—
471357500
—
MN
05
—
7223201
—
MN
Enumeration date
10/17/2006
Last updated
06/27/2015
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