Provider Demographics
NPI:1922370790
Name:ZIENKA, TERESA MARY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARY
Last Name:ZIENKA
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 1:5881 SOM CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-3036
Mailing Address - Country:US
Mailing Address - Phone:440-946-4357
Mailing Address - Fax:440-946-5329
Practice Address - Street 1:5881 SOM CENTER RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3036
Practice Address - Country:US
Practice Address - Phone:440-946-4357
Practice Address - Fax:440-946-5329
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist