Provider Demographics
NPI:1932484359
Name:MAH, TERRY A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:A
Last Name:MAH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 W BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1421
Mailing Address - Country:US
Mailing Address - Phone:818-557-3782
Mailing Address - Fax:818-557-4001
Practice Address - Street 1:1051 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1421
Practice Address - Country:US
Practice Address - Phone:818-557-3782
Practice Address - Fax:818-557-4001
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist