Provider Demographics
NPI:1639545890
Name:SHIERTS, ERIN MARIE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MARIE
Last Name:SHIERTS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 HIGHWAY 65 S
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-1899
Mailing Address - Country:US
Mailing Address - Phone:320-679-1212
Mailing Address - Fax:
Practice Address - Street 1:710 FRANKIE LN
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1914
Practice Address - Country:US
Practice Address - Phone:320-679-2363
Practice Address - Fax:320-679-1620
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist