Provider Demographics
NPI:1134569460
Name:STORM, TERRY LEE (RPH)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:STORM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 ROBIN HOOD DR
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-2625
Mailing Address - Country:US
Mailing Address - Phone:218-681-2932
Mailing Address - Fax:218-681-5041
Practice Address - Street 1:201 HORACE AVE N
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2024
Practice Address - Country:US
Practice Address - Phone:218-681-2932
Practice Address - Fax:218-681-5041
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist