Individual
TERESA FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
650 KIMMELL RD, VINCENNES, IN 47591-6341
(812) 886-0006
Mailing address
650 KIMMELL RD, VINCENNES, IN 47591-6341
(812) 886-0006
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26092133A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26092133A
BOARD OF PHARMACY
IN
Enumeration date
10/28/2020
Last updated
10/28/2020
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