Provider Demographics
NPI:1558842146
Name:BRULEY, TEAGAN RAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TEAGAN
Middle Name:RAE
Last Name:BRULEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DAKOTA AVE N STE A
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-1630
Mailing Address - Country:US
Mailing Address - Phone:605-359-2222
Mailing Address - Fax:605-352-4861
Practice Address - Street 1:17267 W 3RD ST
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:SD
Practice Address - Zip Code:57469-1001
Practice Address - Country:US
Practice Address - Phone:605-472-4231
Practice Address - Fax:605-472-4439
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist