| Organization Name: | ERICKSONS DIVERSIFIED CORPORATION |
| NPI Number: | 1598097602 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES B LINDEN (DIRECTOR OF PHARMACY) |
| Mailing Address: | 1900 Sunrise Dr Saint Peter |
| State: | MN US |
| Postal Code: | 560825802 |
| Phone Number: | 5079317354 |
| Fax Number: | 5079315497 |
| NPI Enumeration Date: | 02/01/2010 |
| NPI Last Update Date: | 02/01/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0002X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Clinic Pharmacy |
| Taxonomy Definition: | A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |