Provider Demographics
NPI:1457634537
Name:DAVIS, TERRY LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33495 HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-3425
Mailing Address - Country:US
Mailing Address - Phone:334-636-8420
Mailing Address - Fax:334-636-9576
Practice Address - Street 1:33495 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-3425
Practice Address - Country:US
Practice Address - Phone:334-636-8420
Practice Address - Fax:334-636-9576
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1619145976Medicaid