Provider Demographics
NPI:1558547075
Name:WANK, TERRI L (PHARM D)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:WANK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CRAVER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SAND LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12196-3006
Mailing Address - Country:US
Mailing Address - Phone:518-626-5721
Mailing Address - Fax:518-626-5729
Practice Address - Street 1:113 HOLLAND AVE
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3410
Practice Address - Country:US
Practice Address - Phone:518-626-5721
Practice Address - Fax:518-626-5729
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039661-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist