Provider Demographics
NPI:1669819991
Name:AGOSTO, TEICHER NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TEICHER
Middle Name:NICOLE
Last Name:AGOSTO
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 1:25613 COLTRANE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872
Mailing Address - Country:US
Mailing Address - Phone:240-372-3656
Mailing Address - Fax:
Practice Address - Street 1:25613 COLTRANE DRIVE
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872
Practice Address - Country:US
Practice Address - Phone:240-372-3656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist