Provider Demographics
NPI:1487923132
Name:PURSEL, TERESA
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:PURSEL
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 1:16640 S COUNTRY CLUB CT
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF LOCH LLOYD
Mailing Address - State:MO
Mailing Address - Zip Code:64012-3376
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16640 S COUNTRY CLUB CT
Practice Address - Street 2:
Practice Address - City:VILLAGE OF LOCH LLOYD
Practice Address - State:MO
Practice Address - Zip Code:64012-3376
Practice Address - Country:US
Practice Address - Phone:816-331-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005040263183500000X
IA16262183500000X
KS1-127041835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist