Provider Demographics
NPI:1093008799
Name:TADIFA, TERESITA B (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:B
Last Name:TADIFA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33235 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-1128
Mailing Address - Country:US
Mailing Address - Phone:510-471-5103
Mailing Address - Fax:
Practice Address - Street 1:12645 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4803
Practice Address - Country:US
Practice Address - Phone:775-853-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist