Provider Demographics
NPI:1528684669
Name:HERTZ, MICHAELA MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:MARIE
Last Name:HERTZ
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 1:930 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:SIBLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51249-1318
Mailing Address - Country:US
Mailing Address - Phone:712-461-0916
Mailing Address - Fax:
Practice Address - Street 1:420 2ND AVE
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:IA
Practice Address - Zip Code:51249-1205
Practice Address - Country:US
Practice Address - Phone:712-754-3859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist