Healthcare Provider Details

I. General information

NPI: 1003802000
Provider Name (Legal Business Name): TERRENCE DALE EYRING RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2005
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 JEURGENS CT STE A
NORCROSS GA
30093-2219
US

IV. Provider business mailing address

2031 CALVIN CT
DULUTH GA
30097-5112
US

V. Phone/Fax

Practice location:
  • Phone: 678-533-6458
  • Fax:
Mailing address:
  • Phone: 770-123-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH022387
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: