Healthcare Provider Details

I. General information

NPI: 1093757940
Provider Name (Legal Business Name): TERRY L COFFEY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SUNSET ST
GRANITE FALLS NC
28630-1770
US

IV. Provider business mailing address

24 MORNINGSIDE DR
GRANITE FALLS NC
28630-9334
US

V. Phone/Fax

Practice location:
  • Phone: 828-396-9858
  • Fax:
Mailing address:
  • Phone: 828-496-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9010
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: