Provider Demographics
NPI:1710254529
Name:TERADA, DALORES (PHARRMD)
Entity Type:Individual
Prefix:
First Name:DALORES
Middle Name:
Last Name:TERADA
Suffix:
Gender:F
Credentials:PHARRMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 GALVIN RD S
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3813
Mailing Address - Country:US
Mailing Address - Phone:402-292-0264
Mailing Address - Fax:
Practice Address - Street 1:1802 GALVIN RD S
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3813
Practice Address - Country:US
Practice Address - Phone:402-292-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist