Provider Demographics
NPI:1194703033
Name:PENNEY, TERESITA MATEO (RX-TECHNICIAN)
Entity type:Individual
Prefix:
First Name:TERESITA
Middle Name:MATEO
Last Name:PENNEY
Suffix:
Gender:F
Credentials:RX-TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8753
Mailing Address - Country:US
Mailing Address - Phone:253-381-6212
Mailing Address - Fax:
Practice Address - Street 1:3601 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5405
Practice Address - Country:US
Practice Address - Phone:253-761-1248
Practice Address - Fax:253-761-7462
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00044510183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician