Healthcare Provider Details

I. General information

NPI: 1629353677
Provider Name (Legal Business Name): TERESA ZUIDEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5403 NORTH BEND AVE.
CINCINNATI OH
45247
US

IV. Provider business mailing address

3712 AULT PARK AVE.
CINCINNATI OH
45208
US

V. Phone/Fax

Practice location:
  • Phone: 513-662-1459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-27416
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: