Provider Demographics
NPI:1558908301
Name:TERLESKY, JOSEPH (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:TERLESKY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49123 WOOSTER CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-8019
Mailing Address - Country:US
Mailing Address - Phone:616-634-4362
Mailing Address - Fax:
Practice Address - Street 1:20645 GIBRALTAR RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-5087
Practice Address - Country:US
Practice Address - Phone:734-675-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist