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General NPI Number Information
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NPI Number | 1871861948
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Entity Type | Individual
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Provider Name | TERRANCE TYRONE FAHLENKAMP PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 1009 S OAKWOOD AVE
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City | GENESEO
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State | IL
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Zip | 61254-1937
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Country | US
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Telephone | 309-944-3784
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Fax |
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Provider Business Mailing Address
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Address Line | 4826 5TH AVE
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City | MOLINE
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State | IL
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Zip | 61265
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Country | US
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Telephone | 309-762-1135
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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 | 051.037640
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13590
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 11249
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License Number State | CO
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