Teaco, INC

NPI #1003234931 in Kennett, Missouri

Provider Information

NPI Number: 1003234931
Entity Type: Organization
Organization Name: Teaco, INC
Primary Specialty: Pharmacy
Enumeration Date: Mar 28, 2014
Last Updated: Mar 28, 2014

Practice Location

Address: 123 1ST ST
City: Kennett
State: Missouri
ZIP Code: 63857-2051
Phone: (573) 888-9094

Authorized Official

Name: JERID MADDOX, PHARM.D.
Title: OWNER
Phone: (573) 888-6673

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacy	333600000X	Primary

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