Provider Demographics
NPI:1740581065
Name:TETKOWSKI, ANN MARIE (RPH, PD)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:TETKOWSKI
Suffix:
Gender:F
Credentials:RPH, PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 CHAPEL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1637
Mailing Address - Country:US
Mailing Address - Phone:410-451-4775
Mailing Address - Fax:410-451-4473
Practice Address - Street 1:2644 CHAPEL LAKE DR
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1637
Practice Address - Country:US
Practice Address - Phone:410-451-4775
Practice Address - Fax:410-451-4473
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist