Provider Demographics
NPI:1396701058
Name:TEAL, BECKY CAPPS (DPH)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:CAPPS
Last Name:TEAL
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 MOUNT PELIA RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-5466
Mailing Address - Country:US
Mailing Address - Phone:731-587-9509
Mailing Address - Fax:731-587-6528
Practice Address - Street 1:319 LINDELL STREET
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237
Practice Address - Country:US
Practice Address - Phone:731-587-9509
Practice Address - Fax:731-587-6528
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist