Provider Demographics
NPI:1649878836
Name:TEED, MORIAH M
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:M
Last Name:TEED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-2807
Mailing Address - Country:US
Mailing Address - Phone:607-743-6061
Mailing Address - Fax:
Practice Address - Street 1:115 EAST NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701
Practice Address - Country:US
Practice Address - Phone:570-822-2791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP455001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist