Provider Demographics
NPI:1548587348
Name:COULTER, TERRI J (RPH)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:J
Last Name:COULTER
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 1:1177 S ROSEMONT RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2152
Mailing Address - Country:US
Mailing Address - Phone:757-486-4427
Mailing Address - Fax:757-486-4101
Practice Address - Street 1:1177 S ROSEMONT RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-2152
Practice Address - Country:US
Practice Address - Phone:757-486-4427
Practice Address - Fax:757-486-4101
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist