Provider Demographics
NPI:1982203923
Name:BREZINKA, CHELSEA RAE
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:RAE
Last Name:BREZINKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 206TH LN NW
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55011-5020
Mailing Address - Country:US
Mailing Address - Phone:763-237-4615
Mailing Address - Fax:
Practice Address - Street 1:300 21ST AVE N
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-6271
Practice Address - Country:US
Practice Address - Phone:763-389-1148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist