Provider Demographics
NPI:1043591142
Name:TESKA, CORY (PHARMD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:TESKA
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 1:3960 E CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0300
Mailing Address - Country:US
Mailing Address - Phone:480-759-1368
Mailing Address - Fax:480-759-9085
Practice Address - Street 1:3960 E CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0300
Practice Address - Country:US
Practice Address - Phone:480-759-1368
Practice Address - Fax:480-759-9085
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist