MEDICARE: DR. MICHELLE MARIA KAESS PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	119049	MN
2	183500000X	Pharmacist	21374	IA

General Provider Information

NPI Number	:	1902183361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE MARIA KAESS PHARMD

Provider Business Mailing Address
First Line	:	4202 PHEASANT RIDGE DR NE
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55449-4529
Country	:	US
Telephone Number	:	651-255-1498
Fax Number	:

Provider Business Practice Location Address
First Line	:	4202 PHEASANT RIDGE DR NE
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55449-4529
Country	:	US
Telephone Number	:	651-255-1498
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2011
Last Update Date	:	11/12/2011

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