Provider Demographics
NPI:1912234824
Name:TEEGERSTROM, LYNETTE ANN (RPH)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:ANN
Last Name:TEEGERSTROM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:ANN
Other - Last Name:REUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5210 3RD ST NE APT 302
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6337
Mailing Address - Country:US
Mailing Address - Phone:402-239-4132
Mailing Address - Fax:
Practice Address - Street 1:6900 GEORGIA AVE NW
Practice Address - Street 2:BLDG 2 ROOM 6P02
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0003
Practice Address - Country:US
Practice Address - Phone:202-782-3727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist