Healthcare Provider Details

I. General information

NPI: 1083438063
Provider Name (Legal Business Name): CHRISTOPHER JOHN TERRY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E MAIN ST
BENSON NC
27504-1530
US

IV. Provider business mailing address

1415 CANE MILL RD
COATS NC
27521-9019
US

V. Phone/Fax

Practice location:
  • Phone: 919-207-0637
  • Fax:
Mailing address:
  • Phone: 919-796-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number33558
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: