Provider Demographics
NPI:1457787954
Name:HARVEY, TEAL MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TEAL
Middle Name:MARIE
Last Name:HARVEY
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:PO BOX 1712
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-0050
Mailing Address - Country:US
Mailing Address - Phone:530-713-1965
Mailing Address - Fax:
Practice Address - Street 1:12775 HONCUT RD
Practice Address - Street 2:
Practice Address - City:LOMA RICA
Practice Address - State:CA
Practice Address - Zip Code:95901-9122
Practice Address - Country:US
Practice Address - Phone:530-713-1965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA672811835G0303X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric