MEDICARE: TERRI L BULLARD PHARMD

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	4746132-1701	UT
2	183500000X	Pharmacist	61547	TX

General Provider Information

NPI Number	:	1780157784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI L BULLARD PHARMD

Provider Business Mailing Address
First Line	:	622 COUNTY ROAD 4797
Second Line	:
City	:	BOYD
State	:	TX
Zip	:	76023-5632
Country	:	US
Telephone Number	:	801-230-4375
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 W ROCK ISLAND AVE
Second Line	:
City	:	BOYD
State	:	TX
Zip	:	76023-3103
Country	:	US
Telephone Number	:	940-433-8056
Fax Number	:

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

Provider Enumeration Date	:	01/02/2019
Last Update Date	:	01/02/2019

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Directions to “ TERRI L BULLARD PHARMD” Practice Location

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