Provider Demographics
NPI:1063008423
Name:KERBEL, MARK SOLOMON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SOLOMON
Last Name:KERBEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 RANCHVIEW LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-3936
Mailing Address - Country:US
Mailing Address - Phone:763-898-8133
Mailing Address - Fax:
Practice Address - Street 1:6445 RANCHVIEW LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-3936
Practice Address - Country:US
Practice Address - Phone:763-898-8133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist