Provider Demographics
NPI:1679171508
Name:ZIERDT, SHELLY (RPH)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:ZIERDT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 100TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-4302
Mailing Address - Country:US
Mailing Address - Phone:612-308-5637
Mailing Address - Fax:
Practice Address - Street 1:9451 DUNKIRK LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-5447
Practice Address - Country:US
Practice Address - Phone:763-416-2300
Practice Address - Fax:763-416-2303
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN118210OtherPHARMACIST LICENSE