Healthcare Provider Details

I. General information

NPI: 1639477888
Provider Name (Legal Business Name): ROBERT TETTEH PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 N DUPONT BLVD
MILFORD DE
19963-1001
US

IV. Provider business mailing address

677 N DUPONT BLVD
MILFORD DE
19963-1001
US

V. Phone/Fax

Practice location:
  • Phone: 302-422-3341
  • Fax:
Mailing address:
  • Phone: 302-422-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0003971
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP444082
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: