NPIMap

Organization Active NPI

Erickson Drug Inc

  • Community/Retail Pharmacy
  • Lakeville, MN
National Provider Identifier
1629159736
Registry record updated Jun 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2004130 Issued in MN
Legal business name
ERICKSON DRUG INC
Doing business as
ERICKSON DRUG INC
Practice address
20751 Holyoke Ave
Lakeville, MN 55044-9825
Phone
(952) 469-2964
Fax
(952) 469-6753
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2015

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

Authorized official

Name
Robert Koziol, PHARMDNPI 1619150919
Title
Owner and Secretary Treasurer
Phone
(952) 469-2964

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 2004130 MN Primary

Addresses

Primary practice location

20751 Holyoke Ave
Lakeville, MN 55044-9825

Mailing address

PO Box 808
Lakeville, MN 55044-0808

Other identifiers 3

IdentifierTypeStateIssuer
2044557OtherPK
7223201MedicaidMN
471357500MedicaidMN

Other names 1

  • ERICKSON DRUG INC Doing business as

National Provider Directory

National Provider Directory

Locations

20751 Holyoke Ave
Lakeville, MN 55044
Phone (952) 469-2964

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435363200000",
    "number": "1629159736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 808",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550440808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20751 HOLYOKE AVE",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550449825",
            "telephone_number": "952-469-2964",
            "fax_number": "952-469-6753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERICKSON DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2015-06-27",
        "status": "A",
        "authorized_official_last_name": "KOZIOL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER AND SECRETARY TREASURER",
        "authorized_official_telephone_number": "952-469-2964",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "2004130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2044557",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7223201",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "471357500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ERICKSON DRUG INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2015; 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.