MEDICARE: MS. TERESSA A ANTHONY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202011697	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0202011697	OTHER	VA	PHARM LICENSE

General Provider Information

NPI Number	:	1083747034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESSA A ANTHONY

Provider Business Mailing Address
First Line	:	704 STRATFORD ST
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23701-4125
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6095 INDIAN RIVER RD
Second Line	:	SUITE 201
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3818
Country	:	US
Telephone Number	:	757-420-7921
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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