Provider Demographics
NPI:1114320835
Name:HERMAN, MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HERMAN
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 1:1138 GOLF CLUB RD SE
Mailing Address - Street 2:APT 102
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2393
Mailing Address - Country:US
Mailing Address - Phone:619-922-0033
Mailing Address - Fax:
Practice Address - Street 1:1138 GOLF CLUB RD SE
Practice Address - Street 2:APT 102
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2393
Practice Address - Country:US
Practice Address - Phone:619-922-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60482964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60482964OtherPHARMACY LICENSE