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General NPI Number Information
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NPI Number | 1417602004
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Entity Type | Individual
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Provider Name | MELODY E TERRY
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Gender | Female
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Dates
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Enumeration Date | 02/13/2022
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Last Update Date | 02/13/2022
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Provider Practice Location Address
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Address Line | 5322 US HIGHWAY 158
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City | ADVANCE
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State | NC
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Zip | 27006-6907
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Country | US
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Telephone | 336-940-5515
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Fax |
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Provider Business Mailing Address
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Address Line | 123 PIEDMONT AVE APT B
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City | WINSTON SALEM
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State | NC
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Zip | 27101-3638
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Country | US
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Telephone | 910-206-4410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 31037
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License Number State | NC
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