Provider Demographics
NPI:1427523844
Name:WEATHERHEAD, TEALE STEFFES (PHARMD)
Entity type:Individual
Prefix:
First Name:TEALE
Middle Name:STEFFES
Last Name:WEATHERHEAD
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 1:6606 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:MT
Mailing Address - Zip Code:59037-9211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1602 MAIN ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-4038
Practice Address - Country:US
Practice Address - Phone:406-245-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT32093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty