Provider Demographics
NPI:1902183361
Name:KAESS, MICHELLE MARIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIA
Last Name:KAESS
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 1:4202 PHEASANT RIDGE DR NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4529
Mailing Address - Country:US
Mailing Address - Phone:651-255-1498
Mailing Address - Fax:
Practice Address - Street 1:4202 PHEASANT RIDGE DR NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4529
Practice Address - Country:US
Practice Address - Phone:651-255-1498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-12
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119049183500000X
IA21374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist