MEDICARE: TERRY MYERS 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	038314	NY

General Provider Information

NPI Number	:	1730180969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY MYERS RPH

Provider Business Mailing Address
First Line	:	124 CAMP ST
Second Line	:
City	:	JAMESTOWN
State	:	NY
Zip	:	14701-7354
Country	:	US
Telephone Number	:	716-484-9538
Fax Number	:	716-945-1520

Provider Business Practice Location Address
First Line	:	77 MAIN ST
Second Line	:
City	:	SALAMANCA
State	:	NY
Zip	:	14779-1529
Country	:	US
Telephone Number	:	716-945-6712
Fax Number	:	716-945-1520

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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