Healthcare Provider Details

I. General information

NPI: 1568651032
Provider Name (Legal Business Name): TERRY HAIR PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 N FAIR OAKS AVE
PASADENA CA
91103-1620
US

IV. Provider business mailing address

1855 N FAIR OAKS AVE
PASADENA CA
91103-1620
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-1214
  • Fax: 626-398-5840
Mailing address:
  • Phone: 626-993-1214
  • Fax: 626-398-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: