Provider Demographics
NPI:1700220274
Name:WHEELER, TERRY LYNN (RPH, JD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:RPH, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4532 YORKDALE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4253
Mailing Address - Country:US
Mailing Address - Phone:770-981-3683
Mailing Address - Fax:
Practice Address - Street 1:4532 YORKDALE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4253
Practice Address - Country:US
Practice Address - Phone:770-981-3683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist