Provider Demographics
NPI:1437469194
Name:ROANE, TERESA ELAINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ELAINE
Last Name:ROANE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23729 NW 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615
Mailing Address - Country:US
Mailing Address - Phone:386-454-5372
Mailing Address - Fax:
Practice Address - Street 1:23729 NW 110TH AVE
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615
Practice Address - Country:US
Practice Address - Phone:386-454-5372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist