Provider Demographics
NPI:1164723979
Name:MATTHEWS, TERRY LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LEE
Last Name:MATTHEWS
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 1:1920 S NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-3407
Mailing Address - Country:US
Mailing Address - Phone:719-636-5257
Mailing Address - Fax:719-448-9818
Practice Address - Street 1:1920 S NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-3407
Practice Address - Country:US
Practice Address - Phone:719-636-5257
Practice Address - Fax:719-448-9818
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist