Provider Demographics
NPI:1801163860
Name:TESLUK, LINDA MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARIE
Last Name:TESLUK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:PLONOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8908 LA SIESTA CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3452
Mailing Address - Country:US
Mailing Address - Phone:512-892-5639
Mailing Address - Fax:
Practice Address - Street 1:8908 LA SIESTA CT
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-3452
Practice Address - Country:US
Practice Address - Phone:512-892-5639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist