Provider Demographics
NPI:1437123700
Name:TERRY, ROYCE MICHAEL (DPH)
Entity Type:Individual
Prefix:DR
First Name:ROYCE
Middle Name:MICHAEL
Last Name:TERRY
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10713 DUNDAS OAK CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2428
Mailing Address - Country:US
Mailing Address - Phone:703-250-0059
Mailing Address - Fax:
Practice Address - Street 1:110 LUKE AVE SW
Practice Address - Street 2:
Practice Address - City:BOLLING AFB
Practice Address - State:DC
Practice Address - Zip Code:20032-6400
Practice Address - Country:US
Practice Address - Phone:202-767-5223
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist