Provider Demographics
NPI:1134728520
Name:KENGNE MBAKAM, HERVE BERTRAND (PHARMD, MS)
Entity type:Individual
Prefix:
First Name:HERVE BERTRAND
Middle Name:
Last Name:KENGNE MBAKAM
Suffix:
Gender:M
Credentials:PHARMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WINDSOR DR S
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-8073
Mailing Address - Country:US
Mailing Address - Phone:320-237-4067
Mailing Address - Fax:
Practice Address - Street 1:1800 WINDSOR DR S
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-8073
Practice Address - Country:US
Practice Address - Phone:612-354-5934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist