Provider Demographics
NPI:1992145544
Name:HERK, CYNTHIA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:HERK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 LUNDORFF DR
Mailing Address - Street 2:
Mailing Address - City:SANDSTONE
Mailing Address - State:MN
Mailing Address - Zip Code:55072-5051
Mailing Address - Country:US
Mailing Address - Phone:320-245-5500
Mailing Address - Fax:320-245-5123
Practice Address - Street 1:204 LUNDORFF DR
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-5051
Practice Address - Country:US
Practice Address - Phone:320-245-5500
Practice Address - Fax:320-245-5123
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119559183500000X
NDRPH4561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist