Provider Demographics
NPI:1790061869
Name:TESTER, ZACHARY (RPH)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:TESTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:ZACHARY
Other - Middle Name:
Other - Last Name:TESTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:4501 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2754
Mailing Address - Country:US
Mailing Address - Phone:218-628-2897
Mailing Address - Fax:218-624-5853
Practice Address - Street 1:4501 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2754
Practice Address - Country:US
Practice Address - Phone:218-628-2897
Practice Address - Fax:218-624-5853
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117675183500000X
WI13783-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist