Provider Demographics
NPI:1083342216
Name:DRISKILL, TERRI ADDERHOLT (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:ADDERHOLT
Last Name:DRISKILL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 EAST MAIN STREET
Mailing Address - Street 2:ADDRESS LINE 2
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804
Mailing Address - Country:US
Mailing Address - Phone:662-844-7811
Mailing Address - Fax:
Practice Address - Street 1:1244 EAST MAIN STREET
Practice Address - Street 2:ADDRESS LINE 2
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804
Practice Address - Country:US
Practice Address - Phone:662-844-7811
Practice Address - Fax:662-844-7876
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-08912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE-08912OtherMISSISSIPPI STATE BOAD OF PHARMACY