Provider Demographics
NPI:1093757940
Name:COFFEY, TERRY L (RPH)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:COFFEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-9334
Mailing Address - Country:US
Mailing Address - Phone:828-496-7552
Mailing Address - Fax:
Practice Address - Street 1:100 SUNSET ST
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-1770
Practice Address - Country:US
Practice Address - Phone:828-396-9858
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist