Provider Demographics
NPI:1609046903
Name:DAHLIN, TERRY GILBERT (RPH)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:GILBERT
Last Name:DAHLIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3664
Mailing Address - Country:US
Mailing Address - Phone:509-966-6850
Mailing Address - Fax:509-966-2690
Practice Address - Street 1:3708 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3664
Practice Address - Country:US
Practice Address - Phone:509-966-6850
Practice Address - Fax:509-966-2690
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist