Basic Information
| Provider Information | |||||||||
| NPI: | 1255458949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAPP | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | ANITA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WILKERSON | ||||||||
| OtherFirstName: | TERESA | ||||||||
| OtherMiddleName: | SAPP | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | PHARMD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 204 CARRINGTON PL | ||||||||
| Address2: | APARTMENT 12 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283140993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108688516 | ||||||||
| FaxNumber: | 9109078506 | ||||||||
| Practice Location | |||||||||
| Address1: | 2817 REILLY ROAD WOMACK ARMY MEDICAL CTR | ||||||||
| Address2: | DEPARTMENT OF PHARMACY STOP A | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109076987 | ||||||||
| FaxNumber: | 9109078506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 11855 | AL | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.