MEDICARE: DR. THERESA KODUA BS, PHARMD

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	S022963	AZ

General Provider Information

NPI Number	:	1952815201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA KODUA BS, PHARMD

Provider Business Mailing Address
First Line	:	5255 E BROADWAY BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5255 E BROADWAY BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3702
Country	:	US
Telephone Number	:	520-917-0130
Fax Number	:

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

Provider Enumeration Date	:	11/24/2017
Last Update Date	:	01/28/2018

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