Provider Demographics
NPI:1952654014
Name:TEUTON, KENNETH ALAN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ALAN
Last Name:TEUTON
Suffix:
Gender:M
Credentials:PHARMD
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Other - Credentials:
Mailing Address - Street 1:300 HOSPITAL RD
Mailing Address - Street 2:INTERDISCIPLINARY PAIN MANAGEMENT CENTER
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-5678
Mailing Address - Fax:706-787-0196
Practice Address - Street 1:300 HOSPITAL RD
Practice Address - Street 2:INTERDISCIPLINARY PAIN MANAGEMENT CENTER
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-5678
Practice Address - Fax:706-787-0196
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC132841835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist