Ericksons Diversified LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

ERICKSONS DIVERSIFIED LLC

Practice address

110 W 4TH St
New Richmond, WI 54017-1722

Phone

(715) 246-2186

Fax

(715) 246-7115

NPI assigned

Jan 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amy Ellis, RPH

Title

Director of Pharmacy

Phone

(616) 878-2848

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• FAMILY FRESH MARKET PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761868800000",
    "number": "1114075488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1527 MOMENTUM PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606895315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W 4TH ST",
            "city": "NEW RICHMOND",
            "state": "WI",
            "postal_code": "540171722",
            "telephone_number": "715-246-2186",
            "fax_number": "715-246-7115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERICKSONS DIVERSIFIED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2025-10-31",
        "certification_date": "2025-10-31",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "616-878-2848",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WI",
            "license": "5254",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "5113054",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33129900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY FRESH MARKET PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAMILY FRESH MARKET PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jean Anna Edwards, M.S.T. CCC-SLP
• Katherine Ellis, PT
• Kelley K Emerson-Quarne, MSW
• Sally Jo Emerson, RN
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• Judith Ann Fall, OTR/L
• Amber E Falls, CSAC
• Family Dentistry SC

• Community/Retail Pharmacy in New Richmond, WI
• Providers in New Richmond, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.