Provider Demographics
NPI:1265822670
Name:TERESCHENKO, VICTORIA
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:TERESCHENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6119 HORSESHOE BAR RD
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-8528
Mailing Address - Country:US
Mailing Address - Phone:916-652-5633
Mailing Address - Fax:916-652-5236
Practice Address - Street 1:6119 HORSESHOE BAR RD
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-8528
Practice Address - Country:US
Practice Address - Phone:916-652-5633
Practice Address - Fax:916-652-5236
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist