Provider Demographics
NPI:1972671816
Name:TEELUCKSINGH, KEITH HORACE RILEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:HORACE RILEY
Last Name:TEELUCKSINGH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 HOLMGREN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8372
Mailing Address - Country:US
Mailing Address - Phone:415-902-0640
Mailing Address - Fax:
Practice Address - Street 1:115 CENTRAL ISLAND ST STE 400
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7320
Practice Address - Country:US
Practice Address - Phone:843-856-7883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS530471835P1200X
SC359201835P1200X
GARRH0290231835P1200X
CA570011835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
141472OtherNAPB