Provider Demographics
NPI:1588089668
Name:ERICKSON, BRIAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MAIN AVE N
Mailing Address - Street 2:PO BOX F
Mailing Address - City:BAGLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56621-8315
Mailing Address - Country:US
Mailing Address - Phone:218-694-6210
Mailing Address - Fax:
Practice Address - Street 1:31 MAIN AVE N
Practice Address - Street 2:PO BOX F
Practice Address - City:BAGLEY
Practice Address - State:MN
Practice Address - Zip Code:56621-8315
Practice Address - Country:US
Practice Address - Phone:218-694-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist