MEDICARE: HAL JOSEPH TEIKEN RPH

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
1	183500000X	Pharmacist	113347	MN

General Provider Information

NPI Number	:	1225477193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAL JOSEPH TEIKEN RPH

Provider Business Mailing Address
First Line	:	808 WASHINGTON AVE
Second Line	:	SUITE 29
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3033
Country	:	US
Telephone Number	:	218-847-9248
Fax Number	:	218-847-8874

Provider Business Practice Location Address
First Line	:	808 WASHINGTON AVE
Second Line	:	SUITE 29
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3033
Country	:	US
Telephone Number	:	218-847-9248
Fax Number	:	218-847-8874

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2013
Last Update Date	:	06/24/2013

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Directions to “ HAL JOSEPH TEIKEN RPH” Practice Location

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