Provider Demographics
NPI:1659620094
Name:ERICKSON, STEVEN ERNEST (RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ERNEST
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 1:2166 N FREEWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-6627
Mailing Address - Country:US
Mailing Address - Phone:208-327-0008
Mailing Address - Fax:
Practice Address - Street 1:2166 N FREEWATER AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-6627
Practice Address - Country:US
Practice Address - Phone:208-327-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV06461183500000X
IDP-3947183500000X
WAPH00011844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist