Provider Demographics
NPI:1669757795
Name:FORSTROM, ERICA (PHARMD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:FORSTROM
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 1:4084 MILLER TRUNK RD
Mailing Address - Street 2:
Mailing Address - City:EVELETH
Mailing Address - State:MN
Mailing Address - Zip Code:55734-4041
Mailing Address - Country:US
Mailing Address - Phone:218-780-5983
Mailing Address - Fax:
Practice Address - Street 1:5474 MOUNTAIN IRON DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-3371
Practice Address - Country:US
Practice Address - Phone:218-741-2421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist