Healthcare Provider Details

I. General information

NPI: 1134569460
Provider Name (Legal Business Name): TERRY LEE STORM R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HORACE AVE N
THIEF RIVER FALLS MN
56701-2024
US

IV. Provider business mailing address

1829 ROBIN HOOD DR
THIEF RIVER FALLS MN
56701-2625
US

V. Phone/Fax

Practice location:
  • Phone: 218-681-2932
  • Fax: 218-681-5041
Mailing address:
  • Phone: 218-681-2932
  • Fax: 218-681-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number115472
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: