Provider Demographics
NPI:1629057880
Name:MUNDHENK, TERRELL LEROY (RPH)
Entity Type:Individual
Prefix:MR
First Name:TERRELL
Middle Name:LEROY
Last Name:MUNDHENK
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 1:7571 CLOVERBROOK PARK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5002
Mailing Address - Country:US
Mailing Address - Phone:937-435-3537
Mailing Address - Fax:
Practice Address - Street 1:8 E DAYTON ST
Practice Address - Street 2:
Practice Address - City:WEST ALEXANDRIA
Practice Address - State:OH
Practice Address - Zip Code:45381-1208
Practice Address - Country:US
Practice Address - Phone:937-839-4551
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-08732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist