Provider Demographics
NPI:1639260979
Name:TERRY, MONICA KAREN (RPH, CDE)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:KAREN
Last Name:TERRY
Suffix:
Gender:F
Credentials:RPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-7119
Mailing Address - Country:US
Mailing Address - Phone:256-835-1013
Mailing Address - Fax:
Practice Address - Street 1:3868 HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:AL
Practice Address - Zip Code:36274-2640
Practice Address - Country:US
Practice Address - Phone:334-863-7511
Practice Address - Fax:334-863-7500
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11655183500000X
LA14521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist