Provider Demographics
NPI:1003809880
Name:TERRY, ASHLEIGH MCINNIS (PD)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEIGH
Middle Name:MCINNIS
Last Name:TERRY
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WALTERS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-4647
Mailing Address - Country:US
Mailing Address - Phone:337-480-8273
Mailing Address - Fax:337-480-8316
Practice Address - Street 1:1000 WALTERS ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4647
Practice Address - Country:US
Practice Address - Phone:337-475-8521
Practice Address - Fax:337-475-8477
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist