Individual
TERI JO TEAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
42783
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000042783
STATE OF TENNESSEE DEPT OF HEALTH
TN
Enumeration date
08/15/2013
Last updated
08/15/2013
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