Provider Demographics
NPI:1114217668
Name:TEAGUE, BRUCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 US HIGHWAY 70A E
Mailing Address - Street 2:
Mailing Address - City:HILDEBRAN
Mailing Address - State:NC
Mailing Address - Zip Code:28637-8108
Mailing Address - Country:US
Mailing Address - Phone:828-397-7479
Mailing Address - Fax:828-397-2031
Practice Address - Street 1:200 US HIGHWAY 70A E
Practice Address - Street 2:
Practice Address - City:HILDEBRAN
Practice Address - State:NC
Practice Address - Zip Code:28637-8108
Practice Address - Country:US
Practice Address - Phone:828-397-7479
Practice Address - Fax:828-397-2031
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-17
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC053611835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy