Healthcare Provider Details

I. General information

NPI: 1407360548
Provider Name (Legal Business Name): PAIGE ANN TEDESCO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 LINN ST
CINCINNATI OH
45203-1314
US

IV. Provider business mailing address

4989 TROUBADOR CT
CINCINNATI OH
45238-6028
US

V. Phone/Fax

Practice location:
  • Phone: 513-233-7100
  • Fax:
Mailing address:
  • Phone: 513-702-8553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03318436
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: