Provider Demographics
NPI:1255420147
Name:ZAWORA, TERRANCE DAVID (RPH)
Entity type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:DAVID
Last Name:ZAWORA
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 1:4715 ZAWORA RD
Mailing Address - Street 2:
Mailing Address - City:KEWADIN
Mailing Address - State:MI
Mailing Address - Zip Code:49648-9124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321B N SAINT JOSEPH
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682
Practice Address - Country:US
Practice Address - Phone:231-271-3881
Practice Address - Fax:231-271-3488
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist