| NPI | 1114075488 |
|---|---|
| NPI Type | NPI-2 Organization |
| Status | Active |
| Enumeration Date | 2007-01-05 |
| Last Updated | 2025-10-31 |
| Authorized Official | Amy Ellis Director of Pharmacy Phone: 6168782848 |
| Mailing Address | 1527 Momentum Pl Chicago, IL 60689-5315 United States 📍 View Map |
| Primary Practice Address | 110 W 4th St New Richmond, WI 54017-1722 United States Phone: (715) 246-2186 | Fax: (715) 246-7115 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| MEDICAID | WI | 33129900 | — |
| Other (non-Medicare) | — | 5113054 | Other ID Number-Commercial Number |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| No | 333600000X – Pharmacy | WI | 5254 |
| Yes | 3336C0003X – Pharmacy, Community/Retail Pharmacy | — | — |
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About NPI 1114075488
Ericksons Diversified Llc is an organization registered in the CMS NPPES NPI Registry with NPI number 1114075488. The primary specialty listed is Pharmacy, Community/Retail Pharmacy. The organization is located in New Richmond, WI. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2007-01-05. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1114075488?
NPI 1114075488 belongs to Ericksons Diversified Llc, a Pharmacy, Community/Retail Pharmacy in New Richmond, WI. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.
Is NPI 1114075488 active?
The current status of NPI 1114075488 in the NPPES registry is Active. The record was last updated on 2025-10-31.
What specialty is NPI 1114075488?
NPI 1114075488 is classified under the taxonomy Pharmacy, Community/Retail Pharmacy. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1114075488?
You can verify NPI 1114075488 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1114075488?
The primary practice address on file for NPI 1114075488 is 110 W 4th St, New Richmond, WI 54017-1722. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1114075488 issued?
NPI 1114075488 was first issued (enumerated) on 2007-01-05. The NPPES record was last updated on 2025-10-31.
Practice Location Map
Ericksons Diversified Llc is located at 110 W 4th St, New Richmond, WI. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Ericksons Diversified Llc. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1114075488. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Pharmacy | 5254 | WI |