Provider Demographics
NPI:1043085194
Name:GELCHU, KADIRO KADIR (PHARMD)
Entity Type:Individual
Prefix:
First Name:KADIRO
Middle Name:KADIR
Last Name:GELCHU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 COUNTY ROAD B2 E APT 236
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1511
Mailing Address - Country:US
Mailing Address - Phone:612-607-3132
Mailing Address - Fax:
Practice Address - Street 1:1440 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4012
Practice Address - Country:US
Practice Address - Phone:651-646-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN126254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist