Provider Demographics
NPI:1679210488
Name:ERICKSON, RUTH CASEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:CASEY
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 BLACKTHORN DR
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1203
Mailing Address - Country:US
Mailing Address - Phone:810-877-0409
Mailing Address - Fax:
Practice Address - Street 1:3691 W M 55
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9607
Practice Address - Country:US
Practice Address - Phone:989-787-3020
Practice Address - Fax:989-787-3020
Is Sole Proprietor?:No
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5351014780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist