Provider Demographics
NPI:1598049579
Name:RICK, TERISA (RPH)
Entity Type:Individual
Prefix:
First Name:TERISA
Middle Name:
Last Name:RICK
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 1:700 SOUTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4655
Mailing Address - Country:US
Mailing Address - Phone:785-827-3974
Mailing Address - Fax:785-826-9688
Practice Address - Street 1:700 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4655
Practice Address - Country:US
Practice Address - Phone:785-827-3974
Practice Address - Fax:785-826-9688
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist