Provider Demographics
NPI:1902680291
Name:MONTANO, TERESA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:MONTANO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 TRACY GROVE RD # A
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731-4707
Mailing Address - Country:US
Mailing Address - Phone:828-708-8450
Mailing Address - Fax:
Practice Address - Street 1:544 TRACY GROVE RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-4707
Practice Address - Country:US
Practice Address - Phone:828-708-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist