Provider Demographics
NPI:1346493244
Name:DICK, TERRY EUGENE (BS)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:EUGENE
Last Name:DICK
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784-4003
Mailing Address - Country:US
Mailing Address - Phone:701-628-2255
Mailing Address - Fax:701-628-2396
Practice Address - Street 1:107 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-4003
Practice Address - Country:US
Practice Address - Phone:701-628-2255
Practice Address - Fax:701-628-2396
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4394183500000X
MN115006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist