Provider Demographics
NPI:1356786503
Name:TEDESCO, ANTHONY ANDREW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ANDREW
Last Name:TEDESCO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 RICCIUTI DR APT 713
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6292
Mailing Address - Country:US
Mailing Address - Phone:914-557-1095
Mailing Address - Fax:
Practice Address - Street 1:225 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1986
Practice Address - Country:US
Practice Address - Phone:508-378-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist