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:
Map and Directions
Authorized official contact:
Name: Ellis, Amy RPH
Phone: (616) 878-2848

Health care specialties

SpecialtyCodeLicense #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 2 years ago

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114075488 NPPES
Other 5113054 OTHER ID NUMBER-COMMERCIAL NUMBER
MEDICAID 33129900 OTHER ID NUMBER-COMMERCIAL NUMBER

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