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General NPI Number Information
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NPI Number | 1578078473
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Entity Type | Individual
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Provider Name | JOHN PAUL TEAGUE
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Gender | Male
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 1560 S IMPERIAL AVE
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City | EL CENTRO
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State | CA
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Zip | 92243-4241
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Country | US
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Telephone | 760-997-7800
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Fax | 760-997-7801
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Provider Business Mailing Address
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Address Line | 1947 HIGGINS LN
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City | EL CENTRO
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State | CA
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Zip | 92243-9542
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Country | US
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Telephone | 760-791-7685
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Fax |
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 10402
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License Number State | CA
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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 | 61480
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License Number State | CA
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