Provider Demographics
NPI:1053626028
Name:VIERKANT, MARY JO (PHARMD, MED, BS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:VIERKANT
Suffix:
Gender:F
Credentials:PHARMD, MED, BS
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 OAKDALE AVENUE NORTH
Mailing Address - Street 2:NORTH MEMORIAL MEDICAL CENTER PHARMACY
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:763-520-4926
Practice Address - Street 1:3300 OAKDALE AVENUE NORTH
Practice Address - Street 2:NORTH MEMORIAL MEDICAL CENTER PHARMACY
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-520-5200
Practice Address - Fax:763-520-4926
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN120058183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist