=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326187451
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERANCE PAUL BRACEY RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6002 BERRYHILL RD
-----------------------------------------------------
City | MILTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32570-5062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-626-5177
-----------------------------------------------------
Fax | 850-626-5167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4848 TIMBER RIDGE DR
-----------------------------------------------------
City | PACE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32571-8002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-995-0722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS33834
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PU5359
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 8083
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------