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NPI Code Detail

MEDICARE: MR. TERRANCE THURMER JR.

MEDICARE: MR. TERRANCE THURMER JR.
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
1183500000XPharmacist117894MN

General Provider Information

NPI Number : 1861014169
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TERRANCE THURMER JR.
Provider Business Mailing Address
First Line : 18390 TROTT BROOK PKWY NW
Second Line :
City : ELK RIVER
State : MN
Zip : 55330-4660
Country : US
Telephone Number : 763-245-8796
Fax Number :
Provider Business Practice Location Address
First Line : 2420 W DIVISION ST
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56301-3926
Country : US
Telephone Number : 320-253-5366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2020
Last Update Date : 05/11/2020

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