Provider Demographics
NPI:1972773844
Name:TELLER, TERRY LEE (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LEE
Last Name:TELLER
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:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:TSAILE
Mailing Address - State:AZ
Mailing Address - Zip Code:86556-0467
Mailing Address - Country:US
Mailing Address - Phone:928-724-3644
Mailing Address - Fax:928-724-3605
Practice Address - Street 1:NAVAJO ROUTE 64 AND 12
Practice Address - Street 2:TSAILE HEALTH CENTER
Practice Address - City:TSAILE
Practice Address - State:AZ
Practice Address - Zip Code:86556-0467
Practice Address - Country:US
Practice Address - Phone:928-724-3644
Practice Address - Fax:928-724-3605
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist