MEDICARE: TERRY JAY HARLEY RPH.

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
1	183500000X	Pharmacist	14168	CO

General Provider Information

NPI Number	:	1467896399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY JAY HARLEY RPH.

Provider Business Mailing Address
First Line	:	4503 JOHN F KENNEDY PKWY
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3250
Country	:	US
Telephone Number	:	970-223-5769
Fax Number	:	970-223-5844

Provider Business Practice Location Address
First Line	:	4503 JOHN F KENNEDY PKWY
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3250
Country	:	US
Telephone Number	:	970-223-5769
Fax Number	:	970-223-5844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	04/22/2013

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