Provider Demographics
NPI:1083720098
Name:HERBEL, ELROY ALAN
Entity Type:Individual
Prefix:
First Name:ELROY
Middle Name:ALAN
Last Name:HERBEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 DODGE CIR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0130
Mailing Address - Country:US
Mailing Address - Phone:701-255-7251
Mailing Address - Fax:
Practice Address - Street 1:917 DODGE CIR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0130
Practice Address - Country:US
Practice Address - Phone:701-255-7251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4602183500000X
SD4927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist