Provider Demographics
NPI:1093097271
Name:MAI, TERESA T (RPH)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:T
Last Name:MAI
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 1:49 STATION LNDG
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5192
Mailing Address - Country:US
Mailing Address - Phone:781-393-5693
Mailing Address - Fax:781-393-5696
Practice Address - Street 1:49 STATION LNDG
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5192
Practice Address - Country:US
Practice Address - Phone:781-393-5693
Practice Address - Fax:781-393-5696
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist