Provider Demographics
NPI:1396182531
Name:TEREBELO, SEYMOUR (RPH)
Entity Type:Individual
Prefix:MR
First Name:SEYMOUR
Middle Name:
Last Name:TEREBELO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:SEYMOUR
Other - Middle Name:
Other - Last Name:TEREBELO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:14200 FENKELL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-3217
Mailing Address - Country:US
Mailing Address - Phone:313-493-1400
Mailing Address - Fax:313-493-1650
Practice Address - Street 1:14200 FENKELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3217
Practice Address - Country:US
Practice Address - Phone:313-493-1400
Practice Address - Fax:313-493-1650
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302018054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist