Provider Demographics
NPI:1902179922
Name:CASMUS, TERESA MOORE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MOORE
Last Name:CASMUS
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 1:1357 W INNES ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3101
Mailing Address - Country:US
Mailing Address - Phone:704-637-6120
Mailing Address - Fax:704-633-6027
Practice Address - Street 1:1357 W INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3101
Practice Address - Country:US
Practice Address - Phone:704-637-6120
Practice Address - Fax:704-633-6027
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist