Healthcare Provider Details

I. General information

NPI: 1831293166
Provider Name (Legal Business Name): MARK PHILIP HERRIMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 DOUGLAS RD
SOUTH BEND IN
46635
US

IV. Provider business mailing address

3355 DOUGLAS RD
SOUTH BEND IN
46635
US

V. Phone/Fax

Practice location:
  • Phone: 574-234-1157
  • Fax:
Mailing address:
  • Phone: 574-234-1157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302031875
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: