Provider Demographics
NPI:1205103371
Name:CISAR, TERESA (RPH)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:CISAR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N NOB HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6565
Mailing Address - Country:US
Mailing Address - Phone:954-916-9713
Mailing Address - Fax:954-916-9765
Practice Address - Street 1:1800 N NOB HILL RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-6565
Practice Address - Country:US
Practice Address - Phone:954-916-9713
Practice Address - Fax:954-916-9765
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9824183500000X
FLPS23185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist