Provider Demographics
NPI:1972114783
Name:TEAGARDEN, JOCELYN DESLAURIERS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:DESLAURIERS
Last Name:TEAGARDEN
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 1:5503 GENESTA WALK
Mailing Address - Street 2:
Mailing Address - City:AFFTON
Mailing Address - State:MO
Mailing Address - Zip Code:63123-2834
Mailing Address - Country:US
Mailing Address - Phone:636-866-5531
Mailing Address - Fax:
Practice Address - Street 1:7422 HIGHWAY N
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7013
Practice Address - Country:US
Practice Address - Phone:636-625-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019032454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist