Healthcare Provider Details

I. General information

NPI: 1275645269
Provider Name (Legal Business Name): TEASLEY DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 ATLANTA ST SE
GRAVETTE AR
72736-9364
US

IV. Provider business mailing address

PO BOX 120
GRAVETTE AR
72736-0120
US

V. Phone/Fax

Practice location:
  • Phone: 479-787-5966
  • Fax: 479-787-5393
Mailing address:
  • Phone: 479-787-5966
  • Fax: 479-787-5393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR13411
License Number StateAR

VIII. Authorized Official

Name: LINDSEY WATFORD
Title or Position: OWNER/PHARMACIST
Credential: PHARMD
Phone: 479-787-5966