Provider Demographics
NPI:1003802000
Name:EYRING, TERRENCE DALE (RPH)
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:DALE
Last Name:EYRING
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 CALVIN CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5112
Mailing Address - Country:US
Mailing Address - Phone:770-123-4567
Mailing Address - Fax:
Practice Address - Street 1:1626 JEURGENS CT STE A
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2219
Practice Address - Country:US
Practice Address - Phone:678-533-6458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-25
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH022387OtherPHARMACIST LICENSE NUMBER