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Organization
TEACO, INC
Active
Organization
TEACO, INC
Active
Other names
Teko Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERID E MADDOX PHARM.D. (PIC)
(573) 888-6673
Entity
Organization
Contact information
Practice address
501 TEACO RD, KENNETT, MO 63857-3721
(573) 888-6673
Mailing address
501 TEACO RD, KENNETT, MO 63857-3721
(573) 888-6673
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2004011813
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2004011813
STATE LICENSE #
MO
01
—
2617225
NCPDP
—
05
—
60095005
—
MO
Enumeration date
08/19/2006
Last updated
10/30/2014
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