MEDICARE: MS. TERRY LYNN ADDISON RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP00003929	NM

General Provider Information

NPI Number	:	1306055157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERRY LYNN ADDISON RPH

Provider Business Mailing Address
First Line	:	PO BOX 550
Second Line	:
City	:	FORT SUMNER
State	:	NM
Zip	:	88119-0550
Country	:	US
Telephone Number	:	505-355-7357
Fax Number	:	505-355-7816

Provider Business Practice Location Address
First Line	:	127 E. SUMNER AVE.
Second Line	:
City	:	FORT SUMNER
State	:	NM
Zip	:	88119-0550
Country	:	US
Telephone Number	:	505-355-7357
Fax Number	:	505-355-7816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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