Provider Demographics
NPI:1588961544
Name:ERICKSON, THOMAS J (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 JOHN C CALHOUN DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-6656
Mailing Address - Country:US
Mailing Address - Phone:803-531-2079
Mailing Address - Fax:
Practice Address - Street 1:1106 JOHN C CALHOUN DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6656
Practice Address - Country:US
Practice Address - Phone:803-531-2079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC008195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist