Provider Demographics
NPI:1861819369
Name:MENTZ, CHERYL RAE (RPH)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:RAE
Last Name:MENTZ
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 1:2004 16TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-4706
Mailing Address - Country:US
Mailing Address - Phone:507-219-8719
Mailing Address - Fax:507-437-8565
Practice Address - Street 1:1000 18TH AVE NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1853
Practice Address - Country:US
Practice Address - Phone:507-434-8170
Practice Address - Fax:507-437-8565
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist