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NPI Code Detail

MEDICARE: MRS. ASHLEIGH MCINNIS TERRY PD

MEDICARE: MRS. ASHLEIGH MCINNIS TERRY PD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist16139LA

General Provider Information

NPI Number : 1003809880
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ASHLEIGH MCINNIS TERRY PD
Provider Business Mailing Address
First Line : 1000 WALTERS ST
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70607-4647
Country : US
Telephone Number : 337-480-8273
Fax Number : 337-480-8316
Provider Business Practice Location Address
First Line : 1000 WALTERS ST
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70607-4647
Country : US
Telephone Number : 337-475-8521
Fax Number : 337-475-8477
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2005
Last Update Date : 04/19/2023

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