Provider Demographics
NPI:1487958864
Name:TESKE, BRADLEY EUGENE (RPH)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:EUGENE
Last Name:TESKE
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 1:951 E FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-2613
Mailing Address - Country:US
Mailing Address - Phone:320-693-3261
Mailing Address - Fax:320-593-3264
Practice Address - Street 1:951 E FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-2613
Practice Address - Country:US
Practice Address - Phone:320-693-3261
Practice Address - Fax:320-593-3264
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1116621835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111662OtherMINNESOTA BOARD OF PHARMACY