Provider Demographics
NPI:1174800015
Name:DAINTY, TERRI
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:DAINTY
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 1:1335 LUE DR
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-2815
Mailing Address - Country:US
Mailing Address - Phone:303-981-1296
Mailing Address - Fax:620-624-5096
Practice Address - Street 1:1335 LUE DR
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-2815
Practice Address - Country:US
Practice Address - Phone:303-981-1296
Practice Address - Fax:620-624-5096
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1-14729OtherLICENSE NUMBER