Healthcare Provider Details

I. General information

NPI: 1821384595
Provider Name (Legal Business Name): THERESA ZOTALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 W 79TH ST
BLOOMINGTON MN
55431-1250
US

IV. Provider business mailing address

2555 W 79TH ST
BLOOMINGTON MN
55431-1250
US

V. Phone/Fax

Practice location:
  • Phone: 952-933-5333
  • Fax: 952-933-5333
Mailing address:
  • Phone: 952-933-5333
  • Fax: 952-933-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number111408
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: