Provider Demographics
NPI:1356931778
Name:TERRELL, TIMOTHY MACK (RPH)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MACK
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 1:4901 GARY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35064-1348
Mailing Address - Country:US
Mailing Address - Phone:205-785-4343
Mailing Address - Fax:205-785-4344
Practice Address - Street 1:4901 GARY AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:AL
Practice Address - Zip Code:35064-1348
Practice Address - Country:US
Practice Address - Phone:205-785-4343
Practice Address - Fax:205-785-4344
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist