Provider Demographics
NPI:1275138810
Name:TEETS, ROBIN (RPH)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:TEETS
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 1:75 HOCKANUM BLVD UNIT 1736
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4069
Mailing Address - Country:US
Mailing Address - Phone:860-416-7567
Mailing Address - Fax:
Practice Address - Street 1:690 WETHERSFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1930
Practice Address - Country:US
Practice Address - Phone:860-296-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist