Provider Demographics
NPI:1033417258
Name:JENNINGS, TERESA BRYANT (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:BRYANT
Last Name:JENNINGS
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:P.O. BOX 715
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021
Mailing Address - Country:US
Mailing Address - Phone:336-983-4165
Mailing Address - Fax:336-983-6336
Practice Address - Street 1:650 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021
Practice Address - Country:US
Practice Address - Phone:336-983-4165
Practice Address - Fax:336-983-6336
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12801183500000X
SC6377183500000X
VA0202007691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist