Healthcare Provider Details

I. General information

NPI: 1073882361
Provider Name (Legal Business Name): JEFFREY SCOTT TERRY PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 6TH
PERRY OK
73077-7020
US

IV. Provider business mailing address

12 WILSHIRE
PERRY OK
73077
US

V. Phone/Fax

Practice location:
  • Phone: 580-336-2136
  • Fax:
Mailing address:
  • Phone: 405-397-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14550
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: