Provider Demographics
NPI:1730311671
Name:TESA PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:TESA PHARMACY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:POORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:704-858-3689
Mailing Address - Street 1:13000 S TRYON ST
Mailing Address - Street 2:STE. F #252
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7652
Mailing Address - Country:US
Mailing Address - Phone:704-858-3689
Mailing Address - Fax:
Practice Address - Street 1:13000 S TRYON ST
Practice Address - Street 2:STE. F #252
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7652
Practice Address - Country:US
Practice Address - Phone:704-858-3689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15569183500000X
SC012409183500000X
PARP443375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty