Organization
TEASLEY DRUG INC
Active
Other names
TEASLEY DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
LINDSEY WATFORD PHARMD (OWNER/PHARMACIST)
(479) 787-5966
Entity
Organization
Contact information
Practice address
205 ATLANTA ST SE, GRAVETTE, AR 72736-9364
(479) 787-5966
(479) 787-5393
Mailing address
PO BOX 120, GRAVETTE, AR 72736-0120
(479) 787-5966
(479) 787-5393
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR13411
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100244910A
—
OK
05
—
176183407
—
AR
01
—
1994355
PK
—
05
—
602301509
—
MO
Enumeration date
08/31/2006
Last updated
02/28/2017
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