Provider Demographics
NPI:1659979029
Name:ANDERSON, TERRI ADAMS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:ADAMS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-1698
Mailing Address - Country:US
Mailing Address - Phone:706-975-5078
Mailing Address - Fax:
Practice Address - Street 1:501 GILBERT RD
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-1698
Practice Address - Country:US
Practice Address - Phone:706-975-5078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16312OtherLICENSE
GA016312OtherPHARMACIST LICENSE
016312OtherPHARMACIST LICENSE