MEDICARE: TESS PROCHAZKA

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	125670	MN

General Provider Information

NPI Number	:	1932824414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESS PROCHAZKA

Provider Business Mailing Address
First Line	:	202 S 2ND AVE
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-2614
Country	:	US
Telephone Number	:	218-749-6333
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 S 2ND AVE
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-2614
Country	:	US
Telephone Number	:	218-749-6333
Fax Number	:

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

Provider Enumeration Date	:	10/07/2022
Last Update Date	:	10/07/2022

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Directions to “ TESS PROCHAZKA ” Practice Location

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