Provider Demographics
NPI:1710027503
Name:HARBERG, TERESA DIANE (RPH)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:DIANE
Last Name:HARBERG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:DIANE
Other - Last Name:BLANC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:35400 18TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-6908
Mailing Address - Country:US
Mailing Address - Phone:253-235-5015
Mailing Address - Fax:
Practice Address - Street 1:34509 9TH AVE S STE 308
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8710
Practice Address - Country:US
Practice Address - Phone:253-944-6985
Practice Address - Fax:253-944-7585
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist