Provider Demographics
NPI:1609849397
Name:TERRY, HEATHER L (CPHT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:TERRY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 PED RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37892-3427
Mailing Address - Country:US
Mailing Address - Phone:423-569-3191
Mailing Address - Fax:423-569-7801
Practice Address - Street 1:279 UNDERPASS DR
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-5885
Practice Address - Country:US
Practice Address - Phone:423-569-7800
Practice Address - Fax:423-569-7801
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13747183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician