Individual
KELLY BLYTHE-TEATS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 E EMPIRE ST, BLOOMINGTON, IL 61704-3532
(309) 662-7004
(309) 662-6650
Mailing address
1701 E EMPIRE ST, BLOOMINGTON, IL 61704-3532
(309) 662-7004
(309) 662-6650
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051293809
IL
Other
Enumeration date
07/12/2018
Last updated
07/12/2018
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