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General NPI Number Information
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NPI Number | 1922697085
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Entity Type | Individual
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Provider Name | DR. DEREK TEA
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Gender | Male
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 5115 W BASELINE RD
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City | LAVEEN
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State | AZ
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Zip | 85339-3000
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Country | US
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Telephone | 602-283-1603
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Fax |
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Provider Business Mailing Address
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Address Line | 5151 N 16TH ST APT 4038
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City | PHOENIX
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State | AZ
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Zip | 85016-3817
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Country | US
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Telephone | 562-685-1927
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S024816
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License Number State | AZ
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