Provider Demographics
NPI:1043511751
Name:BAHN, TERESA JO (PHARMD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:JO
Last Name:BAHN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:JO
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:330 W DIMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1903
Mailing Address - Country:US
Mailing Address - Phone:907-267-7116
Mailing Address - Fax:907-344-1297
Practice Address - Street 1:330 W DIMOND BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1903
Practice Address - Country:US
Practice Address - Phone:907-267-7116
Practice Address - Fax:907-344-1297
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist