Provider Demographics
NPI:1902814262
Name:DUKE, TERRY L (R PH)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:L
Last Name:DUKE
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 1010
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:35592
Mailing Address - Country:US
Mailing Address - Phone:205-695-7911
Mailing Address - Fax:205-695-7970
Practice Address - Street 1:170 5TH STREET SOUTHWEST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AL
Practice Address - Zip Code:35592
Practice Address - Country:US
Practice Address - Phone:205-695-7911
Practice Address - Fax:205-695-7970
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0123707Medicare UPIN
AL0991460001Medicare ID - Type Unspecified