1639545890 NPI number — MRS. ERIN MARIE SHIERTS PHARM.D.

Table of content: MRS. ERIN MARIE SHIERTS PHARM.D. (NPI 1639545890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639545890 NPI number — MRS. ERIN MARIE SHIERTS PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIERTS
Provider First Name:
ERIN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
ERIN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639545890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 HIGHWAY 65 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55051-1899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-679-1212
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 FRANKIE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55051-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-679-2363
Provider Business Practice Location Address Fax Number:
320-679-1620
Provider Enumeration Date:
08/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  120821 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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