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General NPI Number Information
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NPI Number | 1528684669
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Entity Type | Individual
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Provider Name | MICHAELA MARIE HERTZ PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 420 2ND AVE
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City | SIBLEY
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State | IA
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Zip | 51249-1205
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Country | US
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Telephone | 712-754-3859
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Fax |
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Provider Business Mailing Address
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Address Line | 930 3RD ST NE
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City | SIBLEY
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State | IA
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Zip | 51249-1318
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Country | US
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Telephone | 712-461-0916
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 23842
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License Number State | IA
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