Provider Demographics
NPI:1417112582
Name:CHEZICK, KATIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:CHEZICK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:HISCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 HIGHWAY 71
Mailing Address - Street 2:RAINY LAKE MEDICAL CENTER
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2154
Mailing Address - Country:US
Mailing Address - Phone:218-283-7872
Mailing Address - Fax:218-283-9814
Practice Address - Street 1:1400 HIGHWAY 71
Practice Address - Street 2:RAINY LAKE MEDICAL CENTER
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2154
Practice Address - Country:US
Practice Address - Phone:218-283-7872
Practice Address - Fax:218-283-9814
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist