Provider Demographics
NPI:1902129828
Name:MERTENS, CHERYL ANN (BSPHARM)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:MERTENS
Suffix:
Gender:F
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-0001
Mailing Address - Country:US
Mailing Address - Phone:715-246-8667
Mailing Address - Fax:
Practice Address - Street 1:132 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LUCK
Practice Address - State:WI
Practice Address - Zip Code:54853
Practice Address - Country:US
Practice Address - Phone:715-472-2122
Practice Address - Fax:715-472-4423
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11179183500000X
MN114480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist