Provider Demographics
NPI:1225633274
Name:DEXTRAZE, THERESA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:DEXTRAZE
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 1:300 CAMERON DR
Mailing Address - Street 2:
Mailing Address - City:DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02715-1532
Mailing Address - Country:US
Mailing Address - Phone:774-872-1012
Mailing Address - Fax:
Practice Address - Street 1:255 WARNER BLVD
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-8300
Practice Address - Country:US
Practice Address - Phone:508-824-1057
Practice Address - Fax:508-822-0140
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist