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General NPI Number Information
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NPI Number | 1356455778
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Entity Type | Organization
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Legal Business Name | TEACO, INC
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 501 TEACO RD
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City | KENNETT
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State | MO
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Zip | 63857-3721
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Country | US
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Telephone | 573-888-6673
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Fax |
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Provider Business Mailing Address
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Address Line | 501 TEACO RD
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City | KENNETT
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State | MO
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Zip | 63857-3721
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Country | US
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Telephone | 573-888-6673
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Fax |
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Authorized Official
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Title or Position | PIC
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Name | MR. JERID E MADDOX
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Credential | PHARM.D.
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Telephone | 573-888-6673
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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 | 2004011813
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License Number State | MO
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