Healthcare Provider Details

I. General information

NPI: 1598014367
Provider Name (Legal Business Name): TERI VRCHOTICKY RPH, PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 10/07/2022
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 5TH ST S
ST PETERSBURG FL
33701-4804
US

IV. Provider business mailing address

601 5TH ST S
ST PETERSBURG FL
33701-4804
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-8181
  • Fax: 727-767-2590
Mailing address:
  • Phone: 727-767-8181
  • Fax: 727-767-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS34139
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115609
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: