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General NPI Number Information
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NPI Number | 1831516194
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Entity Type | Individual
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Provider Name | MARK EHLERT RPH
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Gender | Male
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 501 HIGHWAY 10 S
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City | SAINT CLOUD
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State | MN
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Zip | 56304-1250
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Country | US
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Telephone | 320-253-5373
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Fax | 320-253-4985
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Provider Business Mailing Address
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Address Line | 829 W MEADOW CT
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City | SARTELL
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State | MN
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Zip | 56377-2271
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Country | US
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Telephone | 320-309-6040
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Fax | 320-253-4985
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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 | 112780
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License Number State | MN
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