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NPI Code Detail

MEDICARE: DR. TEGAN K MAGSAM PHARMD, BCACP, CPP

MEDICARE: DR. TEGAN K MAGSAM PHARMD, BCACP, CPP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist25082NC
21835P2201XAmbulatory Care Pharmacist25082NC
3183500000XPharmacist25082NC

General Provider Information

NPI Number : 1760807226
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TEGAN K MAGSAM PHARMD, BCACP, CPP
Provider Business Mailing Address
First Line : 508 S SAUNDERS ST
Second Line :
City : RALEIGH
State : NC
Zip : 27603-2156
Country : US
Telephone Number : 580-716-3040
Fax Number :
Provider Business Practice Location Address
First Line : 3101 JOHN HUMPHRIES WYND
Second Line :
City : RALEIGH
State : NC
Zip : 27612-5302
Country : US
Telephone Number : 919-881-8272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2014
Last Update Date : 06/23/2020

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