Provider Demographics
NPI:1801122346
Name:ERICKSON, RICHARD MILTON (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MILTON
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 1:2010 S ALMA SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7072
Mailing Address - Country:US
Mailing Address - Phone:480-917-8546
Mailing Address - Fax:480-917-9823
Practice Address - Street 1:2010 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-7072
Practice Address - Country:US
Practice Address - Phone:480-917-8546
Practice Address - Fax:480-917-9823
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012077183500000X
MN115789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist