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
303 S MAIN ST, RIVER FALLS, WI 54022-2468
(715) 425-1325
(844) 216-6806
Mailing address
1527 MOMENTUM PL, CHICAGO, IL 60689-5315
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
6593
WI
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33033400
—
WI
01
—
5116062
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
01/05/2007
Last updated
10/31/2025
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