Provider Demographics
NPI:1518010420
Name:ERICKSON, DALE MARTIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:MARTIN
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2847 LITTLE DRY RUN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-2829
Mailing Address - Country:US
Mailing Address - Phone:513-474-5024
Mailing Address - Fax:513-474-5955
Practice Address - Street 1:7110 BACHMAN RD
Practice Address - Street 2:
Practice Address - City:SARDINIA
Practice Address - State:OH
Practice Address - Zip Code:45171-9456
Practice Address - Country:US
Practice Address - Phone:937-446-2545
Practice Address - Fax:937-446-2600
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03114704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist