Provider Demographics
NPI:1134322845
Name:MAXWELL, ERICK A
Entity Type:Individual
Prefix:MR
First Name:ERICK
Middle Name:A
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-2710
Mailing Address - Country:US
Mailing Address - Phone:402-614-9758
Mailing Address - Fax:402-592-2501
Practice Address - Street 1:600 NORTHGATE PKWY
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3201
Practice Address - Country:US
Practice Address - Phone:402-592-5244
Practice Address - Fax:402-592-2501
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician