Provider Demographics
NPI:1659842383
Name:JOEL, TERRY LYNN
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:LYNN
Last Name:JOEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-7326
Mailing Address - Country:US
Mailing Address - Phone:662-332-2010
Mailing Address - Fax:
Practice Address - Street 1:202 E STARLING ST # 1
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4707
Practice Address - Country:US
Practice Address - Phone:662-332-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist