Provider Demographics
NPI:1821304346
Name:KIRK, TERESA W (RPH)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:W
Last Name:KIRK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:897 LYNNHAVEN PKWY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7203
Mailing Address - Country:US
Mailing Address - Phone:757-368-3273
Mailing Address - Fax:757-368-2960
Practice Address - Street 1:897 LYNNHAVEN PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7203
Practice Address - Country:US
Practice Address - Phone:757-368-3273
Practice Address - Fax:757-368-2960
Is Sole Proprietor?:No
Enumeration Date:2010-08-21
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist