Provider Demographics
NPI:1831378165
Name:KIRCHNER, TERESA A (RPH)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:KIRCHNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-5425
Mailing Address - Country:US
Mailing Address - Phone:518-283-2171
Mailing Address - Fax:
Practice Address - Street 1:329 GLENMONT RD
Practice Address - Street 2:
Practice Address - City:GLENMONT
Practice Address - State:NY
Practice Address - Zip Code:12077-3468
Practice Address - Country:US
Practice Address - Phone:518-433-4711
Practice Address - Fax:518-433-4715
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist