Provider Demographics
NPI:1750659652
Name:MAHER, KIRSTEN DYNEA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:DYNEA
Last Name:MAHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16395 WAGNER WAY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5754
Mailing Address - Country:US
Mailing Address - Phone:952-457-2169
Mailing Address - Fax:
Practice Address - Street 1:16395 WAGNER WAY
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5754
Practice Address - Country:US
Practice Address - Phone:952-937-2934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist