Provider Demographics
NPI:1376829325
Name:TEETER, ELLEN BROOKS (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:BROOKS
Last Name:TEETER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 COMMENTRY DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4595
Mailing Address - Country:US
Mailing Address - Phone:501-673-4336
Mailing Address - Fax:
Practice Address - Street 1:702 MILITARY RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3311
Practice Address - Country:US
Practice Address - Phone:501-860-7373
Practice Address - Fax:501-860-6704
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist