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General NPI Number Information
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NPI Number | 1700871852
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Entity Type | Organization
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Legal Business Name | TERRY'S PHARMACY INC
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 1719 NE 16TH AVE
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City | PORTLAND
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State | OR
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Zip | 97212-4422
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Country | US
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Telephone | 503-288-4646
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Fax | 503-288-7200
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Provider Business Mailing Address
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Address Line | 1719 NE 16TH AVE
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City | PORTLAND
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State | OR
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Zip | 97212-4422
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Country | US
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Telephone | 503-288-4646
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Fax | 503-288-7200
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Authorized Official
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Title or Position | PRES.
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Name | MR. TERRANCE D GERLACH
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Credential | RPH
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Telephone | 503-288-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | RP0000443-CS
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License Number State | OR
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