Provider Demographics
NPI:1316346869
Name:WESSELS, TARA CHRISTINE (PHARMD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:CHRISTINE
Last Name:WESSELS
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 1:551 VICTORY AVE APT 326
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4796
Mailing Address - Country:US
Mailing Address - Phone:320-894-9745
Mailing Address - Fax:
Practice Address - Street 1:551 VICTORY AVE APT 326
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4796
Practice Address - Country:US
Practice Address - Phone:320-894-9745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist