Provider Demographics
NPI:1538493895
Name:FOX, THERESA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:FOX
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:M
Other - Last Name:HOPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-8648
Mailing Address - Country:US
Mailing Address - Phone:218-999-1880
Mailing Address - Fax:218-999-1881
Practice Address - Street 1:1601 GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-8648
Practice Address - Country:US
Practice Address - Phone:218-999-1880
Practice Address - Fax:218-999-1881
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist