Provider Demographics
NPI:1609121821
Name:ERICKSON, HOLLY ANN (PHARM D)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:ERICKSON
Suffix:
Gender:F
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 1:1100 13TH AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3376
Mailing Address - Country:US
Mailing Address - Phone:701-281-5695
Mailing Address - Fax:701-281-4804
Practice Address - Street 1:1100 13TH AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3376
Practice Address - Country:US
Practice Address - Phone:701-281-5695
Practice Address - Fax:701-281-4804
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-14
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist