Provider Demographics
NPI:1033191697
Name:TEDESCO, DAVID A (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:TEDESCO
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 1:544 BRADFORD AVE
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2332
Mailing Address - Country:US
Mailing Address - Phone:215-491-2308
Mailing Address - Fax:215-887-4505
Practice Address - Street 1:110 S EASTON RD
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4001
Practice Address - Country:US
Practice Address - Phone:215-887-4577
Practice Address - Fax:215-887-4505
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP024741L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist