Provider Demographics
NPI:1396977500
Name:ESTEP, TERESA VACCA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:VACCA
Last Name:ESTEP
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 RYECROFT RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1524
Mailing Address - Country:US
Mailing Address - Phone:205-663-9665
Mailing Address - Fax:334-265-9796
Practice Address - Street 1:10 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36105-1655
Practice Address - Country:US
Practice Address - Phone:334-265-3336
Practice Address - Fax:334-265-9796
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist