MEDICARE: DR. KEITH HORACE RILEY TEELUCKSINGH PHARM.D.

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
1	1835P1200X	Pharmacotherapy Pharmacist	PS53047	FL
2	1835P1200X	Pharmacotherapy Pharmacist	35920	SC
3	1835P1200X	Pharmacotherapy Pharmacist	RRH029023	GA
4	1835P1200X	Pharmacotherapy Pharmacist	57001	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141472	OTHER		NAPB

General Provider Information

NPI Number	:	1972671816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH HORACE RILEY TEELUCKSINGH PHARM.D.

Provider Business Mailing Address
First Line	:	3579 HOLMGREN ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-8372
Country	:	US
Telephone Number	:	415-902-0640
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 CENTRAL ISLAND ST STE 400
Second Line	:
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-7320
Country	:	US
Telephone Number	:	843-856-7883
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	06/13/2016

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Directions to “ DR. KEITH HORACE RILEY TEELUCKSINGH PHARM.D.” Practice Location

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