Healthcare Provider Details

I. General information

NPI: 1073895926
Provider Name (Legal Business Name): MICHELLE NICOLE HERR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10905 ULYSSES ST NE
BLAINE MN
55434-3827
US

IV. Provider business mailing address

11769 NAPLES CIR NE
BLAINE MN
55449-5839
US

V. Phone/Fax

Practice location:
  • Phone: 763-252-0687
  • Fax: 763-252-0693
Mailing address:
  • Phone: 763-486-2541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number118519
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: