MEDICARE: DR. TERESA PURSEL

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	2005040263	MO
2	183500000X	Pharmacist	16262	IA
3	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	1-12704	KS

General Provider Information

NPI Number	:	1487923132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA PURSEL

Provider Business Mailing Address
First Line	:	16640 S COUNTRY CLUB CT
Second Line	:
City	:	VILLAGE OF LOCH LLOYD
State	:	MO
Zip	:	64012-3376
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16640 S COUNTRY CLUB CT
Second Line	:
City	:	VILLAGE OF LOCH LLOYD
State	:	MO
Zip	:	64012-3376
Country	:	US
Telephone Number	:	816-331-4834
Fax Number	:

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

Provider Enumeration Date	:	12/27/2011
Last Update Date	:	12/27/2011

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