Provider Demographics
NPI:1578905303
Name:TEEGARDEN, COURTNEY MCGILL (PHARMD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MCGILL
Last Name:TEEGARDEN
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 1:211 W YOAKUM AVE
Mailing Address - Street 2:
Mailing Address - City:CHAFFEE
Mailing Address - State:MO
Mailing Address - Zip Code:63740-1138
Mailing Address - Country:US
Mailing Address - Phone:573-887-3622
Mailing Address - Fax:573-887-3309
Practice Address - Street 1:211 W YOAKUM AVE
Practice Address - Street 2:
Practice Address - City:CHAFFEE
Practice Address - State:MO
Practice Address - Zip Code:63740-1138
Practice Address - Country:US
Practice Address - Phone:573-887-3622
Practice Address - Fax:573-887-3309
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013026235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist