Provider Demographics
NPI:1922579085
Name:KERTZNER, MINDY
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:KERTZNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:EINHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:112 HILLSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3148
Mailing Address - Country:US
Mailing Address - Phone:732-370-2500
Mailing Address - Fax:
Practice Address - Street 1:112 HILLSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3148
Practice Address - Country:US
Practice Address - Phone:732-370-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03967900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist