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NPI Code Detail

MEDICARE: HEATHER TERESIAK PHARMD

MEDICARE: HEATHER TERESIAK PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist123629MN

General Provider Information

NPI Number : 1841826914
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER TERESIAK PHARMD
Provider Business Mailing Address
First Line : 19421 YELLOWPINE ST NW
Second Line :
City : OAK GROVE
State : MN
Zip : 55011-8000
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3633 BUNKER LAKE BLVD NW
Second Line :
City : ANDOVER
State : MN
Zip : 55304-7402
Country : US
Telephone Number : 763-421-5011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2020
Last Update Date : 03/20/2020

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Directions to “ HEATHER TERESIAK PHARMD” Practice Location

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