Provider Demographics
NPI:1801907639
Name:TEICHMAN, DAVID ELLIOT (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ELLIOT
Last Name:TEICHMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3595
Mailing Address - Country:US
Mailing Address - Phone:201-837-6368
Mailing Address - Fax:201-837-9363
Practice Address - Street 1:1430 QUEEN ANNE RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3595
Practice Address - Country:US
Practice Address - Phone:201-837-6368
Practice Address - Fax:201-837-9363
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R800276700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4292901Medicaid
NJ4292901Medicaid