Provider Demographics
NPI:1073895926
Name:HERR, MICHELLE NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:NICOLE
Last Name:HERR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11769 NAPLES CIR NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5839
Mailing Address - Country:US
Mailing Address - Phone:763-486-2541
Mailing Address - Fax:
Practice Address - Street 1:10905 ULYSSES ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3827
Practice Address - Country:US
Practice Address - Phone:763-252-0687
Practice Address - Fax:763-252-0693
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist