Provider Demographics
NPI:1023236627
Name:DUFRESNE, TERESA L
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:DUFRESNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13089 GRANT CIR
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-8100
Mailing Address - Country:US
Mailing Address - Phone:810-691-5293
Mailing Address - Fax:
Practice Address - Street 1:218 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2032
Practice Address - Country:US
Practice Address - Phone:810-659-9112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI032852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist