Provider Demographics
NPI:1013213214
Name:TERRY, MARIAN L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:L
Last Name:TERRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3436 SUGAR CREEK CV
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1084
Mailing Address - Country:US
Mailing Address - Phone:321-591-0255
Mailing Address - Fax:
Practice Address - Street 1:3436 SUGAR CREEK CV
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-1084
Practice Address - Country:US
Practice Address - Phone:321-591-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist