Provider Demographics
NPI:1356711923
Name:TERRELL, MONTROSE G (RPH)
Entity type:Individual
Prefix:MR
First Name:MONTROSE
Middle Name:G
Last Name:TERRELL
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 1:807 STUART DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-7625
Mailing Address - Country:US
Mailing Address - Phone:919-776-9320
Mailing Address - Fax:919-777-7238
Practice Address - Street 1:3310 NC 87 S
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-9628
Practice Address - Country:US
Practice Address - Phone:919-776-9399
Practice Address - Fax:919-777-7238
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist