Provider Demographics
NPI:1457674731
Name:NEESON, TERESA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:NEESON
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 1:46 PICKWICK DR N
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6321
Mailing Address - Country:US
Mailing Address - Phone:516-921-0408
Mailing Address - Fax:
Practice Address - Street 1:111 TERRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3848
Practice Address - Country:US
Practice Address - Phone:631-265-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist