Provider Demographics
NPI:1972885887
Name:ANDRADE, TERESA M (RPH)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:M
Last Name:ANDRADE
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 1:5096 E 105TH LN
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7610
Mailing Address - Country:US
Mailing Address - Phone:219-662-7947
Mailing Address - Fax:
Practice Address - Street 1:5096 E 105TH LN
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7610
Practice Address - Country:US
Practice Address - Phone:219-662-7947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist