Healthcare Provider Details

I. General information

NPI: 1912435652
Provider Name (Legal Business Name): CHRISTINE ARIELLE TEBBE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 05/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W SUNSHINE ST
SPRINGFIELD MO
65807-2240
US

IV. Provider business mailing address

11331 N STATE HIGHWAY V
WALNUT GROVE MO
65770-8412
US

V. Phone/Fax

Practice location:
  • Phone: 417-836-1350
  • Fax:
Mailing address:
  • Phone: 417-788-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2013022796
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: