Provider Demographics
NPI:1326187451
Name:BRACEY, TERANCE PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:TERANCE
Middle Name:PAUL
Last Name:BRACEY
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 1:4848 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8002
Mailing Address - Country:US
Mailing Address - Phone:850-995-0722
Mailing Address - Fax:
Practice Address - Street 1:6002 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-5062
Practice Address - Country:US
Practice Address - Phone:850-626-5177
Practice Address - Fax:850-626-5167
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33834183500000X
FLPU5359183500000X
TN8083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist