Provider Demographics
NPI:1063772358
Name:BURKS, TERESA MONIQUE (PHARM D)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MONIQUE
Last Name:BURKS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 SNOWY PLOVER LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-5334
Mailing Address - Country:US
Mailing Address - Phone:843-830-8702
Mailing Address - Fax:
Practice Address - Street 1:409 SNOWY PLOVER LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-5334
Practice Address - Country:US
Practice Address - Phone:843-830-8702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20568183500000X
SC12305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist