Healthcare Provider Details

I. General information

NPI: 1720680895
Provider Name (Legal Business Name): TERRY SPEARS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 HILLCREST DR STE A
VERNON TX
76384-4099
US

IV. Provider business mailing address

PO BOX 1737
VERNON TX
76385-1737
US

V. Phone/Fax

Practice location:
  • Phone: 940-552-2999
  • Fax: 940-552-5347
Mailing address:
  • Phone: 940-552-2999
  • Fax: 940-552-5347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24588
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: