Provider Demographics
NPI:1750504809
Name:WHEELOUS, TERESA A (R PH)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:WHEELOUS
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10164 PLACID LAKE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2567
Mailing Address - Country:US
Mailing Address - Phone:410-997-9717
Mailing Address - Fax:
Practice Address - Street 1:FDA, WHITE OAK, BLDG. 22, RM 4344
Practice Address - Street 2:10903 NEW HAMPSHIRE AVENUE
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903
Practice Address - Country:US
Practice Address - Phone:301-796-1161
Practice Address - Fax:301-796-9842
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist