Healthcare Provider Details

I. General information

NPI: 1710070743
Provider Name (Legal Business Name): CYNTHIA ANN EDELEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CYNTHIA ANN KERN PHARM.D., BCPP

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 4TH ST NW
FARIBAULT MN
55021-5031
US

IV. Provider business mailing address

17793 LAYTON PATH
LAKEVILLE MN
55044-5217
US

V. Phone/Fax

Practice location:
  • Phone: 507-384-6830
  • Fax: 651-431-7757
Mailing address:
  • Phone: 952-892-6989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number114669-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: