Provider Demographics
NPI:1477906550
Name:CHARNETSKI, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:CHARNETSKI
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 1:1007 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:BEAR CREEK TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18702-9790
Mailing Address - Country:US
Mailing Address - Phone:570-814-6207
Mailing Address - Fax:
Practice Address - Street 1:33 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1701
Practice Address - Country:US
Practice Address - Phone:570-825-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450611183500000X
PARPI010599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist