Provider Demographics
NPI:1134705585
Name:TERRY, BRANDON L (CPHT)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:L
Last Name:TERRY
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 OAK ST
Mailing Address - Street 2:
Mailing Address - City:JANE LEW
Mailing Address - State:WV
Mailing Address - Zip Code:26378-6948
Mailing Address - Country:US
Mailing Address - Phone:681-238-8332
Mailing Address - Fax:
Practice Address - Street 1:200 EMILY DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-5500
Practice Address - Country:US
Practice Address - Phone:304-918-6056
Practice Address - Fax:304-918-6039
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230037671183700000X
WVPT0010763183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician