Provider Demographics
NPI:1487786067
Name:SHORTS, THERESA M (RPH)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:SHORTS
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 1:2027 CAESAR PL PH
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-1865
Mailing Address - Country:US
Mailing Address - Phone:718-292-1856
Mailing Address - Fax:718-665-2123
Practice Address - Street 1:320 W 145TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3031
Practice Address - Country:US
Practice Address - Phone:212-939-0941
Practice Address - Fax:212-939-0945
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037706-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist