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General NPI Number Information
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NPI Number | 1821200031
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Entity Type | Individual
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Provider Name | GARY J TERESO PHARM D
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 759 CHESTNUT ST
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City | SPRINGFIELD
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State | MA
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Zip | 01199-1001
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Country | US
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Telephone | 413-794-3940
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Fax |
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Provider Business Mailing Address
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Address Line | 26 CATAUMET LN
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-4463
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Country | US
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Telephone | 413-736-7328
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 23722
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 8865
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License Number State | CT
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