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NPI Code Detail

MEDICARE: TEDD MARCEAU

MEDICARE: TEDD MARCEAU
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist7162OR
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist7162OR

General Provider Information

NPI Number : 1073920955
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEDD MARCEAU
Provider Business Mailing Address
First Line : 20120 PINEBROOK BLVD
Second Line :
City : BEND
State : OR
Zip : 97702-2537
Country : US
Telephone Number : 541-389-5440
Fax Number : 541-389-5382
Provider Business Practice Location Address
First Line : 20120 PINEBROOK BLVD
Second Line :
City : BEND
State : OR
Zip : 97702-2537
Country : US
Telephone Number : 541-389-5440
Fax Number : 541-389-5382
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2014
Last Update Date : 01/29/2016

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Directions to “ TEDD MARCEAU ” Practice Location

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