Family Fresh Market Pharmacy
LBN: Ericksons Diversified Corporation
Family Fresh Market Pharmacy is an health care organization with primary practice located at 110 W 4Th St , New Richmond WI 54017-1722. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Ericksons Diversified Corporation can be contacted via phone (715) 246-2186, or through Ellis, Amy via phone (616) 878-2848.
Contact Information
Primary practice address
110 W 4Th St
New Richmond WI 54017-1722
Phone: (715) 246-2186
Fax: (715) 246-7115
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | 5254 | Wisconsin |
| Suppliers / Community/Retail Pharmacy | 3336C0003X |
Profile Details
| NPI number | 1114075488 |
|---|---|
| LBN Legal business name | Ericksons Diversified Corporation |
| DBA Doing business as | Family Fresh Market Pharmacy |
| Authorized official | Ellis, Amy RPH |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jan 5th, 2007 |
| Last updated | Dec 7th, 2023 - about last year |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114075488 | NPPES |
| Other | 5113054 | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| MEDICAID | 33129900 | OTHER ID NUMBER-COMMERCIAL NUMBER |
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