Provider Demographics
NPI:1760807226
Name:MAGSAM, TEGAN K (PHARMD, BCACP, CPP)
Entity Type:Individual
Prefix:DR
First Name:TEGAN
Middle Name:K
Last Name:MAGSAM
Suffix:
Gender:M
Credentials:PHARMD, BCACP, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 S SAUNDERS ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-2156
Mailing Address - Country:US
Mailing Address - Phone:580-716-3040
Mailing Address - Fax:
Practice Address - Street 1:3101 JOHN HUMPHRIES WYND
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5302
Practice Address - Country:US
Practice Address - Phone:919-881-8272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC250821835P0018X, 1835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care