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General NPI Number Information
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NPI Number | 1730311671
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Entity Type | Organization
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Legal Business Name | TESA PHARMACY SERVICES INC
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Dates
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Enumeration Date | 08/11/2009
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 13000 S TRYON ST STE. F #252
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City | CHARLOTTE
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State | NC
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Zip | 28278-7652
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Country | US
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Telephone | 704-858-3689
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Fax |
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Provider Business Mailing Address
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Address Line | 13000 S TRYON ST STE. F #252
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City | CHARLOTTE
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State | NC
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Zip | 28278-7652
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Country | US
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Telephone | 704-858-3689
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC DEWAYNE POORE
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Credential | PHARM. D
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Telephone | 704-858-3689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 012409
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP443375
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 15569
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License Number State | NC
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