Provider Demographics
NPI:1760103246
Name:ERICKSON, EMILY (RPH)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 E 1400 S
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-3070
Mailing Address - Country:US
Mailing Address - Phone:801-678-8051
Mailing Address - Fax:
Practice Address - Street 1:725 N REDWOOD RD
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-2832
Practice Address - Country:US
Practice Address - Phone:385-322-7900
Practice Address - Fax:385-322-7966
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8441467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist