Provider Demographics
NPI:1093378473
Name:WILLEMS, TERRI A
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:A
Last Name:WILLEMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15240 E ILIFF AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4516
Mailing Address - Country:US
Mailing Address - Phone:303-481-3922
Mailing Address - Fax:303-481-3905
Practice Address - Street 1:15240 E ILIFF AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4516
Practice Address - Country:US
Practice Address - Phone:303-481-3922
Practice Address - Fax:303-481-3905
Is Sole Proprietor?:No
Enumeration Date:2019-04-21
Last Update Date:2019-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist