Provider Demographics
NPI:1235760463
Name:BARDEN, TERRANCE JAMES JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:JAMES
Last Name:BARDEN
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 PINE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1944
Mailing Address - Country:US
Mailing Address - Phone:810-987-7333
Mailing Address - Fax:810-987-2426
Practice Address - Street 1:3530 PINE GROVE AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1944
Practice Address - Country:US
Practice Address - Phone:810-987-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist