Provider Demographics
NPI:1497870471
Name:FROST, TERRY P (DPH)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:P
Last Name:FROST
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 1:1206 LAKE RISE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-5824
Mailing Address - Country:US
Mailing Address - Phone:615-264-4555
Mailing Address - Fax:
Practice Address - Street 1:420 W MAIN STREET
Practice Address - Street 2:FREDS PHARMACY
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-451-2455
Practice Address - Fax:615-451-4284
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist