Provider Demographics
NPI:1548537236
Name:ERICKSON, PETER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 W 147TH ST
Mailing Address - Street 2:
Mailing Address - City:POSEN
Mailing Address - State:IL
Mailing Address - Zip Code:60469-1438
Mailing Address - Country:US
Mailing Address - Phone:708-385-8922
Mailing Address - Fax:
Practice Address - Street 1:3145 W 147TH ST
Practice Address - Street 2:
Practice Address - City:POSEN
Practice Address - State:IL
Practice Address - Zip Code:60469-1438
Practice Address - Country:US
Practice Address - Phone:708-385-8922
Practice Address - Fax:414-464-5438
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist