Provider Demographics
NPI:1508313479
Name:ERICKSON, DOUGLAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
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 1:1601 OLD GREENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-6855
Mailing Address - Country:US
Mailing Address - Phone:844-871-4773
Mailing Address - Fax:844-871-4776
Practice Address - Street 1:1601 OLD GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-6855
Practice Address - Country:US
Practice Address - Phone:844-871-4773
Practice Address - Fax:844-871-4776
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15150183500000X
PARP449445183500000X
TN39037183500000X
SC9856183500000X
FLPS30438183500000X
NE14842183500000X
VA202208924183500000X
WVRP0009855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist