Provider Demographics
NPI:1225477193
Name:TEIKEN, HAL JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:JOSEPH
Last Name:TEIKEN
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 1:808 WASHINGTON AVE
Mailing Address - Street 2:SUITE 29
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3033
Mailing Address - Country:US
Mailing Address - Phone:218-847-9248
Mailing Address - Fax:218-847-8874
Practice Address - Street 1:808 WASHINGTON AVE
Practice Address - Street 2:SUITE 29
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3033
Practice Address - Country:US
Practice Address - Phone:218-847-9248
Practice Address - Fax:218-847-8874
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist