Provider Demographics
NPI:1922378629
Name:KIRSCHENMAN, TANYA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:KIRSCHENMAN
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 1:9049 COUNTY ROAD 8 SW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:MN
Mailing Address - Zip Code:55390-8623
Mailing Address - Country:US
Mailing Address - Phone:612-382-4233
Mailing Address - Fax:
Practice Address - Street 1:601 W CHANDLER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MN
Practice Address - Zip Code:55307-2127
Practice Address - Country:US
Practice Address - Phone:507-964-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist