Healthcare Provider Details

I. General information

NPI: 1043085194
Provider Name (Legal Business Name): KADIRO KADIR GELCHU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 UNIVERSITY AVE W
SAINT PAUL MN
55104-4012
US

IV. Provider business mailing address

165 COUNTY ROAD B2 E APT 236
LITTLE CANADA MN
55117-1511
US

V. Phone/Fax

Practice location:
  • Phone: 651-646-8858
  • Fax:
Mailing address:
  • Phone: 612-607-3132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number126254
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: