Provider Demographics
NPI:1427330224
Name:HALTERMAN, TEENA (RPH)
Entity type:Individual
Prefix:
First Name:TEENA
Middle Name:
Last Name:HALTERMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 HIDDEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-9739
Mailing Address - Country:US
Mailing Address - Phone:217-652-7611
Mailing Address - Fax:
Practice Address - Street 1:1050 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-1078
Practice Address - Country:US
Practice Address - Phone:217-483-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist