Provider Demographics
NPI:1952695074
Name:TESSUM, MICHAEL CURTIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CURTIS
Last Name:TESSUM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7535 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-1287
Mailing Address - Country:US
Mailing Address - Phone:763-425-5300
Mailing Address - Fax:763-425-5300
Practice Address - Street 1:7535 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-1287
Practice Address - Country:US
Practice Address - Phone:763-425-5300
Practice Address - Fax:763-425-5300
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist