Provider Demographics
NPI:1568472439
Name:TERRY'S PHARMACY, INC.
Entity Type:Organization
Organization Name:TERRY'S PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RISSA
Authorized Official - Middle Name:P
Authorized Official - Last Name:TAMER
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:423-562-4928
Mailing Address - Street 1:310 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3617
Mailing Address - Country:US
Mailing Address - Phone:423-562-4928
Mailing Address - Fax:423-566-4044
Practice Address - Street 1:310 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3617
Practice Address - Country:US
Practice Address - Phone:423-562-4928
Practice Address - Fax:423-566-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000117332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3536986Medicaid
TN0236210001Medicare NSC
TN3536986Medicaid