Provider Demographics
NPI:1922526862
Name:TERRANCE, EBONI MARINI (PHARMD)
Entity Type:Individual
Prefix:
First Name:EBONI
Middle Name:MARINI
Last Name:TERRANCE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EBONI
Other - Middle Name:MARINI
Other - Last Name:NORMAN-TERRANCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:220 SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:831-469-0366
Mailing Address - Fax:831-469-0281
Practice Address - Street 1:220 SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2161
Practice Address - Country:US
Practice Address - Phone:831-469-0366
Practice Address - Fax:831-469-0281
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA619703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy