Provider Demographics
NPI:1033860689
Name:TEDESCHI, ADAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:TEDESCHI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 RAZORBACK DR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-2801
Mailing Address - Country:US
Mailing Address - Phone:906-482-5988
Mailing Address - Fax:
Practice Address - Street 1:995 RAZORBACK DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-2801
Practice Address - Country:US
Practice Address - Phone:906-482-5988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist