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General NPI Number Information
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NPI Number | 1235410283
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Entity Type | Individual
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Provider Name | TERESA L MUCKLEY RPH
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Gender | Female
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Dates
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Enumeration Date | 09/05/2011
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Last Update Date | 09/05/2011
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Provider Practice Location Address
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Address Line | 9 N STATE ST
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City | NORTH VERNON
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State | IN
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Zip | 47265-1723
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Country | US
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Telephone | 812-346-4834
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Fax | 812-346-7058
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Provider Business Mailing Address
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Address Line | 940 DRIFTWOOD AVE
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City | COLUMBUS
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State | IN
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Zip | 47203-1083
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Country | US
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Telephone | 812-378-9934
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Fax | 812-346-7058
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26016862A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS22922
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH19932
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License Number State | MA
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