ERICKSONS DIVERSIFIED CORPORATION (NPI# 1952459224) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952459224 |
| Entity Type | Organization |
| Organization Name | ERICKSONS DIVERSIFIED CORPORATION |
| Other Organization Name | FAMILY FRESH MARKET PHARMACY |
| Practice Address |
612 S Minnesota Ave Saint Peter MN 56082-2100 |
| Mailing Address |
1527 Momentum Pl Chicago IL 60689-5315 |
| Practice Telephone | 5079315540 |
| Practice Fax Number | 5079319028 |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2019-08-26 |
| Authorized Official Name | EDDIE GARCIA (DIRECTOR OF PHARMACY) |
| Authorized Official Telephone | 6168782975 |
| Authorized Official Credential | R.PH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | 2008521 | MN | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 342358100 | 05 | |
| OTHER ID NUMBER-COMMERCIAL NUMBER | 2408753 | 01 |
| Other Name | Type Code |
|---|---|
| FAMILY FRESH MARKET PHARMACY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043368319 | Ericksons Diversified Corporation | Pharmacy | 603 Division St S, Northfield, MN 55057-2426 | 2007-01-05 |
| 1134277403 | Ericksons Diversified Corporation | Pharmacy | 951 E Frontage Rd, Litchfield, MN 55355-2613 | 2007-01-05 |
| 1720691454 | Ericksons Diversified Corporation | Pharmacy | 107 Parent St, Somerset, WI 54025-7439 | 2020-08-24 |
| 1194873000 | Ericksons Diversified Corporation | Pharmacy | 623 Main St, Red Wing, MN 55066-2249 | 2007-01-08 |
| 1114075488 | Ericksons Diversified Corporation | Pharmacy | 110 W 4th St, New Richmond, WI 54017-1722 | 2007-01-05 |
| 1841348117 | Ericksons Diversified Corporation | Pharmacy | 303 S Main St, River Falls, WI 54022-2468 | 2007-01-05 |
| 1861540130 | Ericksons Diversified Corporation | Pharmacy | 115 Elm St, Farmington, MN 55024-1033 | 2007-01-05 |
| 1669520938 | Ericksons Diversified Corporation | Pharmacy | 2351 Coulee Rd, Hudson, WI 54016-9177 | 2007-01-05 |
| Street Address |
612 S MINNESOTA AVE |
| City | SAINT PETER |
| State | MN |
| Zip Code | 56082-2100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295276079 | Ashley Jaspers | Nurse Practitioner | 1900 N. Sunrise Drive, Suite #200, St. Peter, MN 56082 | 2017-03-14 |
| 1841730876 | Go Therapy Inc | Speech-Language Pathologist | 830 Sunrise Dr Ste B, Saint Peter, MN 56082 | 2017-02-23 |
| 1487063210 | Ashley Krug | Specialist/Technologist | 800 West College Ave, Saint Peter, MN 56082 | 2014-08-06 |
| 1235578519 | Mikkel Dean Haugen | Dentist | 402 Sunrise Drive, St Peter, MN 56082 | 2013-06-19 |
| 1104163849 | House of Hope, Inc. | Community/Behavioral Health | 201 West Park Row, Suite B, Saint Peter, MN 56082 | 2013-01-15 |
| 1851579700 | Laura J. Hulsebus | Chiropractor | 206 West Walnut St, St Peter, MN 56082 | 2008-02-02 |
| 1588857072 | Michael Joseph Lange | Psychologist | 1703 Csah 15, St. Peter, MN 56082 | 2007-08-20 |
| 1235290420 | Andrew D. Lundquist | Podiatrist | 1901 Oid Minnesota Ave, Mankato Clinic @ Daniel's Health Center, St. Peter, MN 56082 | 2006-12-12 |
| 1962517037 | Mary A Snyder | Dentist | 202 W Walnut, St Peter, MN 56082 | 2006-08-20 |
| 1124041504 | Diane Ruth Bruder | Nurse Practitioner | 2000 Klein Street, St. Peter, MN 56082 | 2006-07-25 |
| Find all providers in zip 56082 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497368633 | Sawtooth Mountain Clinic, Inc. | Pharmacy | 513 5th Ave W Rm 201, Grand Marais, MN 55604-3017 | 2020-08-27 |
| 1891313326 | Rochester Community Pharmacy LLC | Pharmacy | 1604 1st St Nw, Rochester, MN 55901-0318 | 2020-07-10 |
| 1134745730 | Elko New Market Family Pharmacy, LLC | Pharmacy | 117 Old Town Road, Elko New Market, MN 55054 | 2020-06-19 |
| 1578187456 | Coborns Inc | Pharmacy | 15700 88th St Ne, Otsego, MN 55330 | 2020-06-05 |
| 1205460169 | Genoa Healthcare, LLC | Pharmacy | 1515 Energy Park Dr Ste 110, Saint Paul, MN 55108-5229 | 2020-02-28 |
| 1801438361 | The Duluth Clinic, Ltd. | Pharmacy | 2 Division St Ste A, Deer River, MN 56636-8779 | 2019-10-16 |
| 1265084792 | Nudak Ventures, LLC | Pharmacy | 5418 Saint Croix Trl, North Branch, MN 55056-4203 | 2019-07-15 |
| 1659938116 | Sterlingrx Inc | Pharmacy | 1312 Northland Dr Ste 500, Mendota Heights, MN 55120-1436 | 2019-05-21 |
| 1639734346 | Seward Pharmacy LLC | Pharmacy | 2209 E Lake St, Minneapolis, MN 55407-4563 | 2019-05-08 |
| 1093370694 | Minnesota Ave N Pharmacy Services Limited | Pharmacy | 226 Minnesota Ave N, Aitkin, MN 56431-1412 | 2019-05-08 |
| Find all providers with the same taxonomy | ||||
| City | SAINT PETER |
| Zip Code | 56082 |
Please comment or provide details below to improve the information on ERICKSONS DIVERSIFIED CORPORATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.