Provider Demographics
NPI:1265036461
Name:PURTZ, TEAL
Entity Type:Individual
Prefix:
First Name:TEAL
Middle Name:
Last Name:PURTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 SUGAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1208
Mailing Address - Country:US
Mailing Address - Phone:978-807-6399
Mailing Address - Fax:
Practice Address - Street 1:5 MACY ST
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-3706
Practice Address - Country:US
Practice Address - Phone:978-834-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist