Provider Demographics
NPI:1710070743
Name:EDELEN, CYNTHIA ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:EDELEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ANN
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, BCPP
Mailing Address - Street 1:17793 LAYTON PATH
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5217
Mailing Address - Country:US
Mailing Address - Phone:952-892-6989
Mailing Address - Fax:
Practice Address - Street 1:400 4TH ST NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5031
Practice Address - Country:US
Practice Address - Phone:507-384-6830
Practice Address - Fax:651-431-7757
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114669-11835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric