Provider Demographics
NPI:1790359107
Name:TEAGUE, TRISTAN LINETTE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRISTAN
Middle Name:LINETTE
Last Name:TEAGUE
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 1:2025 BUFFALO BEND DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-7426
Mailing Address - Country:US
Mailing Address - Phone:314-359-2370
Mailing Address - Fax:
Practice Address - Street 1:506 FIELDER NORTH PLZ
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2309
Practice Address - Country:US
Practice Address - Phone:817-274-1696
Practice Address - Fax:817-861-8743
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist