Basic Information
| Provider Information | |||||||||
| NPI: | 1922378629 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRSCHENMAN | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9049 COUNTY ROAD 8 SW | ||||||||
| Address2: | |||||||||
| City: | WAVERLY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553908623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123824233 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 601 W CHANDLER ST | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553072127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5079642271 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2012 | ||||||||
| LastUpdateDate: | 01/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 114784 | MN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.