Provider Demographics
NPI:1427372895
Name:TESKE, MICHELLE LYNN (RPH)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LYNN
Last Name:TESKE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3626 BROOKS STREET
Mailing Address - Street 2:KMART PHARMACY
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801
Mailing Address - Country:US
Mailing Address - Phone:406-251-0497
Mailing Address - Fax:406-251-0240
Practice Address - Street 1:3626 BROOKS STREET
Practice Address - Street 2:KMART PHARMACY
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-251-0497
Practice Address - Fax:406-251-0240
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3668183500000X
AZ001012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist