=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043085194
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KADIRO KADIR GELCHU PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2023
-----------------------------------------------------
Last Update Date | 11/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1440 UNIVERSITY AVE W
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55104-4012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-646-8858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 165 COUNTY ROAD B2 E APT 236
-----------------------------------------------------
City | LITTLE CANADA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55117-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-607-3132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 126254
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------