Healthcare Provider Details

I. General information

NPI: 1811398498
Provider Name (Legal Business Name): MICHAEL TEAL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N BENBOW RD
GREENSBORO NC
27411-0001
US

IV. Provider business mailing address

304 POMONA DR. SUITE B AND C
GREENSBORO NC
27407
US

V. Phone/Fax

Practice location:
  • Phone: 336-334-7880
  • Fax:
Mailing address:
  • Phone: 336-337-2794
  • Fax: 336-232-1622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number24186
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: