Provider Demographics
NPI:1659573582
Name:HEROLD, DOUGLAS PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:HEROLD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 TWIFORD ST SW
Mailing Address - Street 2:
Mailing Address - City:CHATFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55923-1233
Mailing Address - Country:US
Mailing Address - Phone:507-867-3807
Mailing Address - Fax:507-287-9604
Practice Address - Street 1:2110 EAST CENTER ST
Practice Address - Street 2:FEDERAL MEDICAL CENTER PHARMACY DEPARTMENT
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55903
Practice Address - Country:US
Practice Address - Phone:507-424-5180
Practice Address - Fax:507-287-9604
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist