Provider Demographics
NPI:1033405550
Name:ANDERSON, TERESA CLARE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:CLARE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15560 PILOT KNOB RD
Mailing Address - Street 2:T-2390
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7286
Mailing Address - Country:US
Mailing Address - Phone:952-236-3166
Mailing Address - Fax:952-236-3176
Practice Address - Street 1:15560 PILOT KNOB RD
Practice Address - Street 2:T-2390
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7286
Practice Address - Country:US
Practice Address - Phone:952-236-3166
Practice Address - Fax:952-236-3176
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist