Provider Demographics
NPI:1023303567
Name:VAN HERK, GENEVIEVE A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:A
Last Name:VAN HERK
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 1:9401 NE CASCADES PKWY
Mailing Address - Street 2:T-2523
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-6824
Mailing Address - Country:US
Mailing Address - Phone:971-230-1931
Mailing Address - Fax:971-230-1941
Practice Address - Street 1:9401 NE CASCADES PKWY
Practice Address - Street 2:T-2523
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-6824
Practice Address - Country:US
Practice Address - Phone:971-230-1931
Practice Address - Fax:971-230-1941
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0011824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist