Provider Demographics
NPI:1851881643
Name:TERRY, LISA GAYLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAYLE
Last Name:TERRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7135
Mailing Address - Country:US
Mailing Address - Phone:270-737-4578
Mailing Address - Fax:270-737-1932
Practice Address - Street 1:111 TOWNE DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8460
Practice Address - Country:US
Practice Address - Phone:270-737-1710
Practice Address - Fax:270-737-1554
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY012686174H00000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No174H00000XOther Service ProvidersHealth Educator