Provider Demographics
NPI:1518737121
Name:SACKETT, TESSA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:MARIE
Last Name:SACKETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:DEER RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:56636-8779
Mailing Address - Country:US
Mailing Address - Phone:218-244-5276
Mailing Address - Fax:
Practice Address - Street 1:2 DIVISION ST
Practice Address - Street 2:
Practice Address - City:DEER RIVER
Practice Address - State:MN
Practice Address - Zip Code:56636-8779
Practice Address - Country:US
Practice Address - Phone:218-246-8642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist