Provider Demographics
NPI:1427708965
Name:GRALL, TERESA M (VA60330084)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:GRALL
Suffix:
Gender:F
Credentials:VA60330084
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 GEORGE WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2626
Mailing Address - Country:US
Mailing Address - Phone:509-943-2605
Mailing Address - Fax:
Practice Address - Street 1:1601 GEORGE WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2626
Practice Address - Country:US
Practice Address - Phone:509-943-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-27
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60330084183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician