Healthcare Provider Details

I. General information

NPI: 1821200031
Provider Name (Legal Business Name): GARY J TERESO PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT ST
SPRINGFIELD MA
01199-1001
US

IV. Provider business mailing address

26 CATAUMET LN
WEST SPRINGFIELD MA
01089-4463
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-3940
  • Fax:
Mailing address:
  • Phone: 413-736-7328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number23722
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number8865
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: