Provider Demographics
NPI:1922588441
Name:TRADER, THERESA (PHARMD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:TRADER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 PYLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BOYCE
Mailing Address - State:VA
Mailing Address - Zip Code:22620-1817
Mailing Address - Country:US
Mailing Address - Phone:540-550-3133
Mailing Address - Fax:
Practice Address - Street 1:1004 PYLETOWN RD
Practice Address - Street 2:
Practice Address - City:BOYCE
Practice Address - State:VA
Practice Address - Zip Code:22620-1817
Practice Address - Country:US
Practice Address - Phone:540-550-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist