Provider Demographics
NPI:1235408881
Name:GITZEN, THERESE (RPH)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:GITZEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2499 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-9701
Mailing Address - Country:US
Mailing Address - Phone:952-470-1425
Mailing Address - Fax:952-252-1076
Practice Address - Street 1:2499 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-9701
Practice Address - Country:US
Practice Address - Phone:952-252-1070
Practice Address - Fax:952-252-1076
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist