MEDICARE: TERESA ZUIDEMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-1-27416	OH

General Provider Information

NPI Number	:	1629353677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ZUIDEMA

Provider Business Mailing Address
First Line	:	3712 AULT PARK AVE.
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5403 NORTH BEND AVE.
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247
Country	:	US
Telephone Number	:	513-662-1459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	10/20/2011

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Directions to “ TERESA ZUIDEMA ” Practice Location

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