Provider Demographics
NPI:1568799310
Name:LITTKE, TERRY L
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:LITTKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND NECK
Mailing Address - State:NC
Mailing Address - Zip Code:27874-1227
Mailing Address - Country:US
Mailing Address - Phone:252-826-3007
Mailing Address - Fax:252-826-0862
Practice Address - Street 1:805 MAIN ST
Practice Address - Street 2:
Practice Address - City:SCOTLAND NECK
Practice Address - State:NC
Practice Address - Zip Code:27874-1227
Practice Address - Country:US
Practice Address - Phone:252-826-3007
Practice Address - Fax:252-826-0862
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist