Healthcare Provider Details

I. General information

NPI: 1760885461
Provider Name (Legal Business Name): TERESA DELELLIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 ERNST RD STE 1200
ROANOKE IN
46783-9711
US

IV. Provider business mailing address

10101 ERNST RD STE 1200
ROANOKE IN
46783-9711
US

V. Phone/Fax

Practice location:
  • Phone: 260-234-5400
  • Fax:
Mailing address:
  • Phone: 260-234-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number26026203A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: