Provider Demographics
NPI:1073922035
Name:EDWARDS, TERRECA TAYLOR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TERRECA
Middle Name:TAYLOR
Last Name:EDWARDS
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 1:105A HILTON CT
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5673
Mailing Address - Country:US
Mailing Address - Phone:225-803-3342
Mailing Address - Fax:
Practice Address - Street 1:3311 PRESCOTT RD STE 110
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3917
Practice Address - Country:US
Practice Address - Phone:318-528-4381
Practice Address - Fax:318-528-4385
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2370545Medicaid