Healthcare Provider Details

I. General information

NPI: 1093050700
Provider Name (Legal Business Name): CHELSEA ANN RASMUSSEN PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA ANN RASMUSSEN PHARMACY TECHNICIAN

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 TOWER AVE ESSENTIA HEALTH SUPERIOR PHARMACY
SUPERIOR WI
54880-5395
US

IV. Provider business mailing address

3500 TOWER AVE ESSENTIA HEALTH SUPERIOR PHARMACY
SUPERIOR WI
54880-5395
US

V. Phone/Fax

Practice location:
  • Phone: 715-817-7880
  • Fax: 715-395-3176
Mailing address:
  • Phone: 715-817-7880
  • Fax: 715-395-3176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number711243
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: