Provider Demographics
NPI:1508118787
Name:STONEBRAKER, TERRIE (RPH)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:
Last Name:STONEBRAKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:THERESE
Other - Last Name:STONEBRAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1750 W UINTAH ST STE A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2972
Mailing Address - Country:US
Mailing Address - Phone:719-636-5046
Mailing Address - Fax:719-633-9140
Practice Address - Street 1:1750 W UINTAH ST STE A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2972
Practice Address - Country:US
Practice Address - Phone:719-636-5046
Practice Address - Fax:719-633-9140
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13979183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist