Healthcare Provider Details

I. General information

NPI: 1235052085
Provider Name (Legal Business Name): TESSA FILOMENA CAROVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24760 HOSPITAL RD
RED LAKE MN
56671
US

IV. Provider business mailing address

23945 500TH ST
BEMIDJI MN
56601-9464
US

V. Phone/Fax

Practice location:
  • Phone: 218-679-0173
  • Fax:
Mailing address:
  • Phone: 530-913-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0136062
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: