Provider Demographics
NPI:1588931885
Name:TEAL, GEORGE DAVID (RPH)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:DAVID
Last Name:TEAL
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 1:3296 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3817
Mailing Address - Country:US
Mailing Address - Phone:910-433-4681
Mailing Address - Fax:
Practice Address - Street 1:3296 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3817
Practice Address - Country:US
Practice Address - Phone:910-433-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist